MEDICARE: BRIDGE FOR INCLUSION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1528802097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE FOR INCLUSION

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	HILLSDALE
State	:	NJ
Zip	:	07642-0112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 CUMBERLAND AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2107
Country	:	US
Telephone Number	:	973-865-6139
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NICHOLAS CHARLES DIDOMENICO
Credential	:
Telephone Number	:	973-865-6139

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	07/08/2024

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Directions to “BRIDGE FOR INCLUSION ” Practice Location

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