Provider Demographics
NPI:1144648965
Name:BRUISED REED FOUNDATION
Entity type:Organization
Organization Name:BRUISED REED FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-932-5005
Mailing Address - Street 1:1665 ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1007
Mailing Address - Country:US
Mailing Address - Phone:760-809-1321
Mailing Address - Fax:
Practice Address - Street 1:50 MORIN AVE
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2111
Practice Address - Country:US
Practice Address - Phone:860-932-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251300000X, 251B00000X, 251E00000X, 251J00000X, 251V00000X, 251X00000X, 332U00000X, 347C00000X, 347E00000X, 385H00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No385H00000XRespite Care FacilityRespite Care