| Organization Name: | BRAVO CARE OF EAST PEORIA INC |
| NPI Number: | 1114114873 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL BRADY (PRESIDENT) |
| Mailing Address: | 900 Centennial Dr East Peoria |
| State: | IL US |
| Postal Code: | 616114928 |
| Phone Number: | 3096995400 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2007 |
| NPI Last Update Date: | 08/18/2008 |
| 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: | |