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General NPI Number Information
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NPI Number | 1104221209
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Entity Type | Organization
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Legal Business Name | BRIDGE HOSPICE LLC
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 119 CANAL ST STE 103
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-417-4571
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Fax | 912-417-4370
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Provider Business Mailing Address
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Address Line | 119 CANAL ST STE 103
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City | POOLER
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State | GA
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Zip | 31322-4094
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Country | US
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Telephone | 912-417-4571
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Fax | 912-417-4370
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. AARON J MUSSELMAN
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Credential |
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Telephone | 912-417-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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