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General NPI Number Information
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NPI Number | 1972693372
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Entity Type | Organization
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Legal Business Name | BRIDGEFORT INC
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 15562 HEMLOCK ST
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City | DETROIT
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State | MI
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Zip | 48235-3843
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Country | US
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Telephone | 313-837-3552
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 760328
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-0328
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Country | US
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Telephone | 313-837-3552
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Fax | 248-569-9201
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. THERESA BROWN
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Credential | MSW
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Telephone | 313-303-2779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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