Healthcare Provider Details

I. General information

NPI: 1467047084
Provider Name (Legal Business Name): BRIDGING INDEPENDENCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11183 ASHLEE BROOK DR
BEALETON VA
22712-2004
US

IV. Provider business mailing address

11183 ASHLEE BROOK DR
BEALETON VA
22712-2004
US

V. Phone/Fax

Practice location:
  • Phone: 434-409-9171
  • Fax:
Mailing address:
  • Phone: 434-409-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERYL MARTIN
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 434-409-9171