Kailey Bradley
Individual provider Active NPI Mental Illness Community Based Residential Treatment Facility · Ashland, OH
NPI 1962864348 · NPPES record last updated Mar 24, 2016
Key facts
- NPI
- 1962864348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- C1400418 (OH)
- Practice address
- 80 Samaritan Ave Apt 1
Ashland, OH 44805-3924 - Phone
- (419) 589-5511
- NPI assigned
- Mar 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2015
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Refuge Counseling
Practice addresses (Care Compare)
Ashland, OH 44805
Phone (419) 922-9696
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240228000285 | OH | Practitioner - Mental Health Counselor | 1456796671 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1400418 | OH | MD | Mental Illness Community Based Residential Treatment Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Refuge Counseling, LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | C1400418 | OH | Yes |
Addresses
Primary practice location
80 Samaritan Ave Apt 1
Ashland, OH 44805-3924
Mailing address
80 Samaritan Ave Apt 1
Ashland, OH 44805-3924
Phone (419) 589-5511
Other providers in Ashland, OH
- Amanda Bowman
- Victoria Bowman
- Beth A Boyd
- Christopher D Boyd
- Brad Hendrickson D.D.S., Inc.
- Wayne Stanford Brechbuhler
- David T. Brennan
- Tylar Brennstuhl
- John Brent
- Brethren Care at Home, LLC
All providers in Ashland, OH · Mental Illness Community Based Residential Treatment Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.