Healthcare Provider Details

I. General information

NPI: 1184378747
Provider Name (Legal Business Name): A BRIDGE 2 WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 ALBEMARLE RD STE 101P
CHARLOTTE NC
28205-6630
US

IV. Provider business mailing address

4822 ALBEMARLE RD STE 101P
CHARLOTTE NC
28205-6630
US

V. Phone/Fax

Practice location:
  • Phone: 980-556-7154
  • Fax: 980-330-4170
Mailing address:
  • Phone: 980-556-7154
  • Fax: 980-330-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANEY WILSON
Title or Position: CEO/DIRECTOR OF OPERATIONS
Credential:
Phone: 980-556-7154