Healthcare Provider Details

I. General information

NPI: 1770257412
Provider Name (Legal Business Name): BRIDGE OF CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 10TH AVE N STE 3
LAKE WORTH FL
33461-6605
US

IV. Provider business mailing address

11401 SW 40TH ST STE 345
MIAMI FL
33165-3372
US

V. Phone/Fax

Practice location:
  • Phone: 561-899-3017
  • Fax: 561-429-2622
Mailing address:
  • Phone: 305-603-7063
  • Fax: 305-603-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: YARITZA AGUIAR RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: CBHCMS
Phone: 305-603-7063