Healthcare Provider Details

I. General information

NPI: 1629994298
Provider Name (Legal Business Name): BRIDAVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 HIGHGROVE WAY
DALLAS GA
30157-7404
US

IV. Provider business mailing address

126 HIGHGROVE WAY
DALLAS GA
30157-7404
US

V. Phone/Fax

Practice location:
  • Phone: 470-350-0650
  • Fax: 470-300-9776
Mailing address:
  • Phone: 470-350-0650
  • Fax: 470-300-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: GRACE ADELUGBA
Title or Position: CEO/ADMIN
Credential:
Phone: 470-350-0650