1558437483 NPI number — BRADY ENTERPRISES, INC

Table of content: (NPI 1558437483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558437483 NPI number — BRADY ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADY ENTERPRISES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOME MED CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558437483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8722 S. 88TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60457-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-598-2882
Provider Business Mailing Address Fax Number:
708-598-4719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8722 S. 88TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKORY HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60457-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-598-2882
Provider Business Practice Location Address Fax Number:
708-598-4719
Provider Enumeration Date:
11/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRADY
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
708-598-2882

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1617750 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".