Healthcare Provider Details

I. General information

NPI: 1043627987
Provider Name (Legal Business Name): BRIDGING COMMUNITY WITH HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W CONGRESS ST
BROOKHAVEN MS
39601-2603
US

IV. Provider business mailing address

1005 W CONGRESS ST 1007 W. CONGRES STREET - MAILING ADDRESS
BROOKHAVEN MS
39601-2603
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-9388
  • Fax: 601-833-9495
Mailing address:
  • Phone: 601-833-9388
  • Fax: 601-833-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR880146
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberR880146
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH W BROWN
Title or Position: OWNER
Credential: DNP
Phone: 601-823-3221