# BRADFORD ECUMENICAL HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831187079
- **Authorized official:** LISA A JOHNSON CEO (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (814) 368-5648

## Contact information

- **Practice address:** 100 SAINT FRANCIS DRIVE, BRADFORD, PA 16701
- **Practice address phone:** (814) 368-5648
- **Practice address fax:** (814) 368-4642
- **Mailing address:** 100 SAINT FRANCIS DRIVE, BRADFORD, PA 16701
- **Mailing address phone:** (814) 368-5648
- **Mailing address fax:** (814) 368-4642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 281402 | PA | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 06/17/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0011692000001 | — | PA |
| 01 | — | 395908 | MEDICARE | PA |