Healthcare Provider Details

I. General information

NPI: 1073324117
Provider Name (Legal Business Name): BRIDGE FOR GENERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 OAKLAND PARK AVE
COLUMBUS OH
43224-3507
US

IV. Provider business mailing address

3663 COURTLAND DR
LEWIS CENTER OH
43035-9181
US

V. Phone/Fax

Practice location:
  • Phone: 614-680-5689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUTH DEBRU
Title or Position: MANAGER
Credential:
Phone: 614-680-5689