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General NPI Number Information
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NPI Number | 1093593386
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Entity Type | Organization
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Legal Business Name | BRIDGE OF CARE GROUP HOME LLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1312 STUBEN DR
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City | DAYTON
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State | OH
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Zip | 45417-8252
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Country | US
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Telephone | 937-305-6637
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Fax |
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Provider Business Mailing Address
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Address Line | 5108 MALIBU CT
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City | TROTWOOD
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State | OH
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Zip | 45426-2353
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Country | US
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Telephone | 937-305-6637
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ASHLEE HAIRSTON
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Credential |
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Telephone | 937-305-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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