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General NPI Number Information
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NPI Number | 1003963778
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Entity Type | Organization
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Legal Business Name | FAMILY BRIDGE HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 118 NORTH AVE SUITE H
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City | JONESBORO
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State | GA
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Zip | 30236-8405
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Country | US
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Telephone | 770-473-4600
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Fax | 770-473-4100
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Provider Business Mailing Address
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Address Line | 118 NORTH AVE SUITE H
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City | JONESBORO
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State | GA
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Zip | 30236-8405
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Country | US
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Telephone | 770-473-4600
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Fax | 770-473-4100
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. CORDELIA O OKWANDU
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Credential | BBA, MA, CNA
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Telephone | 770-473-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 031R0035
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License Number State | GA
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