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NPI Code Detail

MEDICARE: BRIDGE OF HOPE COUNSELING PCA

MEDICARE: BRIDGE OF HOPE COUNSELING PCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1043729858
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGE OF HOPE COUNSELING PCA
Provider Business Mailing Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number : 702-262-1399
Provider Business Practice Location Address
First Line : 5258 S EASTERN AVE STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2327
Country : US
Telephone Number : 702-464-5080
Fax Number : 702-262-1399
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : ANITRA EGNOR
Credential :
Telephone Number : 702-464-5080
Provider Enumeration Date : 09/25/2017
Last Update Date : 07/21/2022

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5258 S EASTERN AVE STE 105
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89119-2327
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1932643962 — MS. KATRINA MARISA HAUSMAN
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5258 S EASTERN AVE STE 105
LAS VEGAS, NV
89119-2327
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Practice Fax:
1326559337 — TRACEY VOOGT
Practice Location Address:
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LAS VEGAS, NV
89119-2327
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1164089488 — CANDLELIGHT MENTAL HEALTH COUNSELING CENTER LLC
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Directions to “BRIDGE OF HOPE COUNSELING PCA ” Practice Location

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