Healthcare Provider Details

I. General information

NPI: 1760356588
Provider Name (Legal Business Name): HOME BRIDGE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 LAKE SHORE DR
BOWIE MD
20721-2905
US

IV. Provider business mailing address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

V. Phone/Fax

Practice location:
  • Phone: 240-286-7404
  • Fax:
Mailing address:
  • Phone: 240-286-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREW OSAZUWA
Title or Position: CEO
Credential:
Phone: 240-286-7404