Healthcare Provider Details

I. General information

NPI: 1609524891
Provider Name (Legal Business Name): LIFE BRIDGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 OLD CHATTANOOGA PIKE SW
CLEVELAND TN
37311-8566
US

IV. Provider business mailing address

PO BOX 29
CLEVELAND TN
37364-0029
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-5268
  • Fax: 423-479-1492
Mailing address:
  • Phone: 142-347-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GINGER DAVIS
Title or Position: CFO
Credential:
Phone: 423-303-1914