Healthcare Provider Details

I. General information

NPI: 1417829409
Provider Name (Legal Business Name): GRAND BRIDGE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CUMMINGS CTR STE 6500
BEVERLY MA
01915-6234
US

IV. Provider business mailing address

500 CUMMINGS CTR STE 6500
BEVERLY MA
01915-6234
US

V. Phone/Fax

Practice location:
  • Phone: 617-729-6827
  • Fax: 617-741-3687
Mailing address:
  • Phone: 617-729-6827
  • Fax: 617-801-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MIKERLINE DOR
Title or Position: CEO
Credential:
Phone: 617-729-6827