Healthcare Provider Details

I. General information

NPI: 1538453337
Provider Name (Legal Business Name): BRIDGES QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4695 HEREFORD ST
DETROIT MI
48224-3915
US

IV. Provider business mailing address

4695 HEREFORD ST
DETROIT MI
48224-3915
US

V. Phone/Fax

Practice location:
  • Phone: 313-318-6381
  • Fax:
Mailing address:
  • Phone: 313-318-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: SHALONDA ZEIGLER
Title or Position: OWNER
Credential:
Phone: 313-318-6381