Healthcare Provider Details

I. General information

NPI: 1609166438
Provider Name (Legal Business Name): BRIDGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 KURT RD
BENTON HARBOR MI
49022-8013
US

IV. Provider business mailing address

2420 KURT RD
BENTON HARBOR MI
49022
US

V. Phone/Fax

Practice location:
  • Phone: 269-252-6857
  • Fax:
Mailing address:
  • Phone: 269-252-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHASITY BRITTANY DRAKE
Title or Position: C.O/DIRECTOR
Credential: RMA
Phone: 269-252-6857