Basic Information
| Provider Information | |||||||||
| NPI: | 1093720880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRADFORD HEIGHTS HEALTH & REHAB CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 N KELLER RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079753000 | ||||||||
| FaxNumber: | 4079753090 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 HIGHPOINT DR | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422402570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708851151 | ||||||||
| FaxNumber: | 2708857461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | RODMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASST. SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4079753011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 90003997 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 314000000X | 100070 | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7100025460 | 05 | KY | MEDICAID | 90003997 | 05 | KY | MEDICAID |