Bradley Royale, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0028712 Issued in IL

Legal business name

BRADLEY ROYALE, INC.

Practice address

650 North Kinzie Avenue
Bradley, IL 60915-1227

Phone

(815) 933-1666

Fax

(815) 933-9866

NPI assigned

Sep 29, 2005

Last updated

Oct 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Penny Varnavas

Title

Administrator

Phone

(815) 933-1666

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222905600000",
    "number": "1992792527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 NORTH KINZIE AVENUE",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151227",
            "telephone_number": "815-933-1666",
            "fax_number": "815-933-9866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NORTH KINZIE AVENUE",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151227",
            "telephone_number": "815-933-1666",
            "fax_number": "815-933-9866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY ROYALE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2008-10-02",
        "status": "A",
        "authorized_official_last_name": "VARNAVAS",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-933-1666"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0028712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Bouldin
• Elna Bovan
• Carl Edward Boyens, LCPC
• Sophia Boyer
• Bradley Bourbonnais School Distrist 307
• Bradley School District #61
• Gerard Breuker, PT, DPT
• Kelly Marie Bufford, PT ATC
• Laura H Burkhalter
• Quincy Lee Campbell

• Skilled Nursing Facility in Bradley, IL
• Providers in Bradley, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.