Healthcare Provider Details

I. General information

NPI: 1487532073
Provider Name (Legal Business Name): SOUL BRIDGES HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 HOLLYWREATH CT
DAYTON OH
45424-4640
US

IV. Provider business mailing address

4840 HOLLYWREATH CT
DAYTON OH
45424-4640
US

V. Phone/Fax

Practice location:
  • Phone: 937-260-2550
  • Fax:
Mailing address:
  • Phone: 937-260-2550
  • Fax:

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: STANISHA SIMS-MONIE
Title or Position: REGISTERED NURSE AND FOUNDER
Credential: RN
Phone: 937-260-2550