The Madera Corp

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

113958 Issued in TX

Legal business name

THE MADERA CORP

Doing business as

The Bradford House

Practice address

1704 North Bradford St
Gilmer, TX 75644

Phone

(903) 843-7601

Fax

(903) 843-4871

NPI assigned

Mar 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Gloria Jeane Madera, LICENSED VOCATIONAL

Title

Vice Pres Sec Treasury

Phone

(903) 843-7601

Specialties & licenses 1

Addresses

Other names 1

• The Bradford House Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124148457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 NORTH BRADFORD ST",
            "city": "GILMER",
            "state": "TX",
            "postal_code": "75644",
            "telephone_number": "903-843-7601",
            "fax_number": "903-843-4871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 NORTH BRADFORD ST",
            "city": "GILMER",
            "state": "TX",
            "postal_code": "75644",
            "telephone_number": "903-843-7601",
            "fax_number": "903-843-4871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MADERA CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MADERA",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "JEANE",
        "authorized_official_title_or_position": "VICE PRES SEC TREASURY",
        "authorized_official_telephone_number": "903-843-7601",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICENSED VOCATIONAL"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "113958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Bradford House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Diane Swanson
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• Mike Terry
• Melanie Teubner-Humber, LPN, CHW
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• Assisted Living Facility in Gilmer, TX
• Providers in Gilmer, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.