MEDICARE: BRIDGEFORT INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	310400000X	Assisted Living Facility	MI
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MI
3	320800000X	Mental Illness Community Based Residential Treatment Facility	MI

General Provider Information

NPI Number	:	1972693372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEFORT INC

Provider Business Mailing Address
First Line	:	PO BOX 760328
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-0328
Country	:	US
Telephone Number	:	313-837-3552
Fax Number	:	248-569-9201

Provider Business Practice Location Address
First Line	:	15562 HEMLOCK ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3843
Country	:	US
Telephone Number	:	313-837-3552
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. THERESA BROWN
Credential	:	MSW
Telephone Number	:	313-303-2779

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	09/11/2025

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Directions to “BRIDGEFORT INC ” Practice Location

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