Healthcare Provider Details

I. General information

NPI: 1124820121
Provider Name (Legal Business Name): BRIDGINGLIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N CHARLES ST
BALTIMORE MD
21218-4300
US

IV. Provider business mailing address

292 STONER AVE
WESTMINSTER MD
21157-5629
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-6300
  • Fax:
Mailing address:
  • Phone: 410-871-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MYERS
Title or Position: CFO CHC
Credential:
Phone: 410-871-6114