Provider Demographics
NPI:1033507249
Name:BRIDGECARE, INC.
Entity Type:Organization
Organization Name:BRIDGECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEMALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-803-2273
Mailing Address - Street 1:2250 E DEVON AVE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4511
Mailing Address - Country:US
Mailing Address - Phone:224-803-2273
Mailing Address - Fax:224-803-2274
Practice Address - Street 1:2250 E DEVON AVE
Practice Address - Street 2:SUITE 333
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4511
Practice Address - Country:US
Practice Address - Phone:224-803-2273
Practice Address - Fax:224-803-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QG0300X, 207RG0300X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty