Provider Demographics
NPI:1275153918
Name:BRIDGE REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:BRIDGE REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:BS BSN CCM
Authorized Official - Phone:800-787-8129
Mailing Address - Street 1:318 JOHN R RD # 302
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4542
Mailing Address - Country:US
Mailing Address - Phone:800-787-8129
Mailing Address - Fax:800-787-7169
Practice Address - Street 1:830 E 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2800
Practice Address - Country:US
Practice Address - Phone:800-727-7859
Practice Address - Fax:800-787-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty