MEDICARE: BRIDAVE HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	376K00000X	Nurse's Aide
3	390200000X	Student in an Organized Health Care Education/Training Program
4	163WH0200X	Home Health Registered Nurse
5	171WH0202X	Home Modifications Contractor
6	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1629994298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDAVE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	126 HIGHGROVE WAY
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-7404
Country	:	US
Telephone Number	:	470-350-0650
Fax Number	:	470-300-9776

Provider Business Practice Location Address
First Line	:	126 HIGHGROVE WAY
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-7404
Country	:	US
Telephone Number	:	470-350-0650
Fax Number	:	470-300-9776

Authorized Official
Title or Position	:	CEO/ADMIN
Name	:	GRACE ADELUGBA
Credential	:
Telephone Number	:	470-350-0650

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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Directions to “BRIDAVE HEALTHCARE LLC ” Practice Location

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