Provider Demographics
NPI:1447357611
Name:THE BRADLEY HOME
Entity type:Organization
Organization Name:THE BRADLEY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:203-235-5716
Mailing Address - Street 1:320 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2053
Mailing Address - Country:US
Mailing Address - Phone:203-235-5716
Mailing Address - Fax:203-235-1440
Practice Address - Street 1:320 COLONY ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2053
Practice Address - Country:US
Practice Address - Phone:203-235-5716
Practice Address - Fax:203-235-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2157-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021577Medicaid
CT07-5439Medicare ID - Type Unspecified