Provider Demographics
NPI:1164398020
Name:ABRIDGE HOME LLC
Entity type:Organization
Organization Name:ABRIDGE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CAULCRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-264-7127
Mailing Address - Street 1:7103 BELFORD PARK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3807
Mailing Address - Country:US
Mailing Address - Phone:832-264-7127
Mailing Address - Fax:
Practice Address - Street 1:20035 JUNIPER BERRY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7233
Practice Address - Country:US
Practice Address - Phone:347-236-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities