Healthcare Provider Details

I. General information

NPI: 1104757137
Provider Name (Legal Business Name): BRIDGE CORE COMMUNITY SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7245 N 74TH AVE
GLENDALE AZ
85303-3046
US

IV. Provider business mailing address

7245 N 74TH AVE
GLENDALE AZ
85303-3046
US

V. Phone/Fax

Practice location:
  • Phone: 602-318-7700
  • Fax: 602-318-7700
Mailing address:
  • Phone: 602-318-7700
  • Fax: 602-318-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MILLION AYELE FIREW
Title or Position: OWNER
Credential: FIREW
Phone: 602-318-7700