Provider Demographics
NPI:1538486915
Name:BRIDGES HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:BRIDGES HOME HEALTHCARE LLC
Other - Org Name:BRIDGES HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TARANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-798-1224
Mailing Address - Street 1:20875 CROSSROADS CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4026
Mailing Address - Country:US
Mailing Address - Phone:262-673-6600
Mailing Address - Fax:877-377-7037
Practice Address - Street 1:20875 CROSSROADS CIR STE 400
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4026
Practice Address - Country:US
Practice Address - Phone:262-673-6600
Practice Address - Fax:877-377-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100012771Medicaid
WI1153OtherWI HOME HEALTH AGENCY LICENSE
WI100012771Medicaid