Healthcare Provider Details

I. General information

NPI: 1093593386
Provider Name (Legal Business Name): BRIDGE OF CARE GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 STUBEN DR
DAYTON OH
45417-8252
US

IV. Provider business mailing address

5108 MALIBU CT
TROTWOOD OH
45426-2353
US

V. Phone/Fax

Practice location:
  • Phone: 937-305-6637
  • Fax:
Mailing address:
  • Phone: 937-305-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEE HAIRSTON
Title or Position: OWNER
Credential:
Phone: 937-305-6637