Healthcare Provider Details

I. General information

NPI: 1972693372
Provider Name (Legal Business Name): BRIDGEFORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15562 HEMLOCK ST
DETROIT MI
48235-3843
US

IV. Provider business mailing address

PO BOX 760328
LATHRUP VILLAGE MI
48076-0328
US

V. Phone/Fax

Practice location:
  • Phone: 313-837-3552
  • Fax:
Mailing address:
  • Phone: 313-837-3552
  • Fax: 248-569-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. THERESA BROWN
Title or Position: DIRECTOR
Credential: MSW
Phone: 313-303-2779