Bradford Home Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

BRADFORD HOME INC.

Practice address

59 Bradford Dr
South San Francisco, CA 94080-1129

Phone

(415) 987-3401

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Estelita Evangelista, RN

Title

Administrator

Phone

(415) 987-3401

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BRADFORD HOME, ICF DDN Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G537

Legal name

THE BRADFORD HOME ICF/DD-N

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Feb 16, 2006

Last certification

Jan 24, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

59 Bradford Drive
South San Francisco, CA 94080

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609082478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 BRADFORD DR",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801129",
            "telephone_number": "415-987-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 BRADFORD DR",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940801129",
            "telephone_number": "415-987-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADFORD HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANGELISTA",
        "authorized_official_first_name": "ESTELITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "415-987-3401",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "55-G537",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRADFORD HOME, ICF DDN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karla Renee Bowles, PH.D., FACMG, CGMB
• Yareli Yurianairi Bowman, OTR/L
• Anna Boyko, RN, NP
• Louise Irene Bracy
• Braden Partners LP
• Traci Lavonne Bradford
• Melissa Garig Brammer, M.D., M.P.H.
• Laurel Elizabeth Bravo
• Susan Esther Brennan, N.P.
• Angela Rose Brickle, MS. CGC

• Intellectual Disabilities Intermediate Care Facility in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.