Organization Name: | BRAVO CARE OF ROCKFORD INC |
NPI Number: | 1003003765 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL BRADY (PRESIDENT) |
Mailing Address: | 1660 S Mulford Rd Rockford |
State: | IL US |
Postal Code: | 611086760 |
Phone Number: | 8153978700 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2007 |
NPI Last Update Date: | 01/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BP3500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Parenteral & Enteral Nutrition |
Taxonomy Definition: |