Healthcare Provider Details

I. General information

NPI: 1518795483
Provider Name (Legal Business Name): BRIDGE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 COTTAGE AVE
SAINT LOUIS MO
63113-3203
US

IV. Provider business mailing address

4001 COTTAGE AVE
SAINT LOUIS MO
63113-3203
US

V. Phone/Fax

Practice location:
  • Phone: 314-405-2053
  • Fax:
Mailing address:
  • Phone: 314-405-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KELLI BRAGGS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-405-2053