Provider Demographics
NPI:1164459129
Name:BRIDGESHOME HEALTH CARE
Entity Type:Organization
Organization Name:BRIDGESHOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES ADMINISTRATIVE A
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-383-2222
Mailing Address - Street 1:5075 WINDFALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-722-4771
Mailing Address - Fax:330-722-8000
Practice Address - Street 1:5075 WINDFALL DRIVE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-722-4771
Practice Address - Fax:330-722-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2021510Medicaid
OH=========00OtherBWC
OH=========00OtherBWC