Senior Bridge LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SENIOR BRIDGE LLC

Practice address

11204 W Greenfield Ave
West Allis, WI 53214-2240

Phone

(414) 988-2228

Fax

(414) 988-2660

NPI assigned

Dec 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kentocc L Coburn

Title

Owner

Phone

(414) 988-2228

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Senior Bridge Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607904000000",
    "number": "1104412295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11204 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532142240",
            "telephone_number": "414-988-2228",
            "fax_number": "414-988-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11204 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532142240",
            "telephone_number": "414-988-2228",
            "fax_number": "414-988-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR BRIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-14",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "KENTOCC",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-988-2228",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100091399",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Bridge Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in West Allis, WI
• Providers in West Allis, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.