Healthcare Provider Details

I. General information

NPI: 1275153918
Provider Name (Legal Business Name): BRIDGE REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 E 4TH ST STE 1
ROYAL OAK MI
48067-2800
US

IV. Provider business mailing address

318 JOHN R RD # 302
TROY MI
48083-4542
US

V. Phone/Fax

Practice location:
  • Phone: 800-727-7859
  • Fax: 800-787-7169
Mailing address:
  • Phone: 800-787-8129
  • Fax: 800-787-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: SONIA SHAH
Title or Position: DIRECTOR
Credential: BS BSN CCM
Phone: 800-787-8129