Healthcare Provider Details

I. General information

NPI: 1366362949
Provider Name (Legal Business Name): BRIDGE TO INDEPENDENCE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 KINGS HOLLOW CT
TOLEDO OH
43617-1656
US

IV. Provider business mailing address

7516 KINGS HOLLOW CT
TOLEDO OH
43617-1656
US

V. Phone/Fax

Practice location:
  • Phone: 313-544-6503
  • Fax:
Mailing address:
  • Phone: 313-544-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELAUNDRA GIBSON
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 313-544-6503