Basic Information
| Provider Information | |||||||||
| NPI: | 1356593719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRADENTON OAKS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 7TH AVE E | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417468108 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1015 7TH AVE E | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342082103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417468108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | EISCH | ||||||||
| AuthorizedOfficialFirstName: | JONENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9417468108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL6662 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 5026 | 01 | FL | UNIVERSAL HEALTH CARE | OTHER |