Provider Demographics
NPI:1992907331
Name:BRIDGERS FAMILY CARE HOME, INC
Entity type:Organization
Organization Name:BRIDGERS FAMILY CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-645-4042
Mailing Address - Street 1:19 POE ELKINS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-7245
Mailing Address - Country:US
Mailing Address - Phone:910-645-4042
Mailing Address - Fax:910-645-6259
Practice Address - Street 1:19 POE ELKINS RD
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-7245
Practice Address - Country:US
Practice Address - Phone:910-645-4042
Practice Address - Fax:910-645-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL009018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803603Medicaid