Individual ProviderGlen Dale BradyLicensed Practical NurseNursing Service ProvidersPractice Address78 Willmont St, Rochester, NY 14609-3620(585) 288-6598PECOS EnrollmentBased on the most recent information from CMS, provider Glen Dale Brady does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:33 PM.Profile DetailsProvider ID1063691533Provider TypeIndividualFull NameBrady, Glen DaleTitleMr.CredentialL.P.NGenderMaleSole ProprietorYesEnumeration Date10/31/2007Last Updated10/31/2007Contact InformationPractice LocationPractice Address78 Willmont St, Rochester, NY 14609-3620Phone(585) 288-6598FaxUnlisted FaxMailing LocationMailing Address78 Willmont St, Rochester, NY 14609-3620Phone(585) 288-6598FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense231182-1New YorkProvider IdentifiersIDDescriptionIssuerID02206848DescriptionMedicaidIssuerUnlistedNew York