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Organization
BRADFORD ECUMENICAL HOME INC
Active
Organization
BRADFORD ECUMENICAL HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A JOHNSON CEO (CHIEF EXECUTIVE OFFICER)
(814) 368-5648
Entity
Organization
Contact information
Practice address
100 SAINT FRANCIS DRIVE, BRADFORD, PA 16701
(814) 368-5648
(814) 368-4642
Mailing address
100 SAINT FRANCIS DRIVE, BRADFORD, PA 16701
(814) 368-5648
(814) 368-4642
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
281402
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011692000001
—
PA
01
—
395908
MEDICARE
PA
Enumeration date
10/12/2005
Last updated
06/17/2015
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