Healthcare Provider Details

I. General information

NPI: 1346160660
Provider Name (Legal Business Name): BRIDGESTONE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22011 BLACKSTONE ST
OAK PARK MI
48237-2854
US

IV. Provider business mailing address

22011 BLACKSTONE ST
OAK PARK MI
48237-2854
US

V. Phone/Fax

Practice location:
  • Phone: 248-810-9446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDON GRENE
Title or Position: OWNER
Credential:
Phone: 248-810-9446