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: 08/15/2026
Certification Date: 08/15/2026
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: 888-741-3687
Mailing address:
  • Phone: 617-729-6827
  • Fax: 888-741-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

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