MEDICARE: BECKY'S BRIDGES, LLC

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
1	251B00000X	Case Management Agency		KS

General Provider Information

NPI Number	:	1568886430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKY'S BRIDGES, LLC

Provider Business Mailing Address
First Line	:	9090 N JENNIE BARKER RD
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-9357
Country	:	US
Telephone Number	:	620-640-9323
Fax Number	:	620-272-0524

Provider Business Practice Location Address
First Line	:	9090 N JENNIE BARKER RD
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-9357
Country	:	US
Telephone Number	:	620-640-9323
Fax Number	:	620-272-0524

Authorized Official
Title or Position	:	OWNER/ TARGETED CASE MANAGER
Name	:	MRS. REBECCA SUE PATTERSON
Credential	:
Telephone Number	:	620-640-9323

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	06/20/2018

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