NPIMap

Organization Active NPI

Bradley Home Caring for Wake Community and Carolinas

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1952512295
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-092-412 Issued in NC
Legal business name
BRADLEY HOME CARING FOR WAKE COMMUNITY AND CAROLINAS
Practice address
6420 Malibu Dr
Raleigh, NC 27603-4908
Phone
(919) 772-9382
Fax
(919) 772-9382
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Cordelia Akagha, MPH
Title
Director
Phone
(919) 772-9382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-092-412 NC Primary

Addresses

Primary practice location

6420 Malibu Dr
Raleigh, NC 27603-4908

Mailing address

PO Box 2055
Garner, NC 27529-2055
Phone (919) 772-9382

Other names 1

  • Kimberly House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bradley Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952512295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2055",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292055",
            "telephone_number": "919-772-9382",
            "fax_number": "919-772-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 MALIBU DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276034908",
            "telephone_number": "919-772-9382",
            "fax_number": "919-772-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY HOME CARING FOR WAKE COMMUNITY AND CAROLINAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AKAGHA",
        "authorized_official_first_name": "CORDELIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-772-9382",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-092-412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kimberly House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • 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.