MEDICARE: NURSINGBRIDGE 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1902690084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSINGBRIDGE LLC

Provider Business Mailing Address
First Line	:	1401 SILVER LAKE RD NW STE 7
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	612-224-1116
Fax Number	:	612-605-0089

Provider Business Practice Location Address
First Line	:	1401 SILVER LAKE RD NW STE 7
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	612-224-1116
Fax Number	:	612-605-0089

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	AYAN KHALIF HASSAN
Credential	:	RN
Telephone Number	:	612-224-1116

Provider Enumeration Date	:	04/05/2025
Last Update Date	:	04/05/2025

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