Healthcare Provider Details

I. General information

NPI: 1669895835
Provider Name (Legal Business Name): BRIDGMAN CARE OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9935 RED ARROW HWY
BRIDGMAN MI
49106-9002
US

IV. Provider business mailing address

PO BOX 579 2532 W. CADILLAC DR
FARWELL MI
48622-0579
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-3017
  • Fax:
Mailing address:
  • Phone: 989-588-3547
  • Fax: 888-849-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN DOYLE THOMPSON
Title or Position: MEMBER
Credential:
Phone: 989-588-3547