Healthcare Provider Details

I. General information

NPI: 1255856936
Provider Name (Legal Business Name): BRIDGE OF CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-603-7063
  • Fax: 305-603-8705
Mailing address:
  • Phone: 305-603-7063
  • Fax: 305-603-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALAIN PEREZ HERNANDEZ
Title or Position: DIRECTOR
Credential: CBHCMS
Phone: 786-368-1112