Healthcare Provider Details

I. General information

NPI: 1538659768
Provider Name (Legal Business Name): BRIDGE HOME HEALTH EAST BAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD REDWOOD HWY STE 106
PETALUMA CA
94954-7128
US

IV. Provider business mailing address

3636 NOBEL DR STE 450
SAN DIEGO CA
92122-1062
US

V. Phone/Fax

Practice location:
  • Phone: 858-251-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFF MONGONIA
Title or Position: CEO
Credential:
Phone: 858-251-4242