Organization
SENIOR BRIDGE LLC
Active
Other names
Senior Bridge Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENTOCC L COBURN (OWNER)
(414) 988-2228
Entity
Organization
Contact information
Practice address
11204 W GREENFIELD AVE, WEST ALLIS, WI 53214-2240
(414) 988-2228
(414) 988-2660
Mailing address
11204 W GREENFIELD AVE, WEST ALLIS, WI 53214-2240
(414) 988-2228
(414) 988-2660
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091399
—
WI
Enumeration date
12/14/2020
Last updated
12/14/2020
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