Healthcare Provider Details

I. General information

NPI: 1104221209
Provider Name (Legal Business Name): BRIDGE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CANAL ST STE 103
POOLER GA
31322
US

IV. Provider business mailing address

119 CANAL ST STE 103
POOLER GA
31322-4094
US

V. Phone/Fax

Practice location:
  • Phone: 912-417-4571
  • Fax: 912-417-4370
Mailing address:
  • Phone: 912-417-4571
  • Fax: 912-417-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON J MUSSELMAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 912-417-4571