Provider Demographics
NPI:1619358504
Name:BRADLEY AND GRAY, INC
Entity type:Organization
Organization Name:BRADLEY AND GRAY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:601-613-4865
Mailing Address - Street 1:4946 COMAL RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3110
Mailing Address - Country:US
Mailing Address - Phone:601-613-4865
Mailing Address - Fax:
Practice Address - Street 1:440 BENMAR DR
Practice Address - Street 2:SUITE 2020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3165
Practice Address - Country:US
Practice Address - Phone:832-232-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS288202291U00000X
MSR894282314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No291U00000XLaboratoriesClinical Medical Laboratory