Provider Demographics
NPI:1538946306
Name:BRADFORD RESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:BRADFORD RESIDENTIAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-233-7489
Mailing Address - Street 1:1111 BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5303
Mailing Address - Country:US
Mailing Address - Phone:626-233-7489
Mailing Address - Fax:626-609-7510
Practice Address - Street 1:1111 BRADFORD DR
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5303
Practice Address - Country:US
Practice Address - Phone:626-233-7489
Practice Address - Fax:626-609-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility