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General NPI Number Information
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NPI Number | 1104419753
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Entity Type | Organization
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Legal Business Name | BRIDGE TO CARE
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 3300 CRAIN ST
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City | SKOKIE
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State | IL
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Zip | 60076-2408
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Country | US
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Telephone | 773-616-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 CRAIN ST
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City | SKOKIE
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State | IL
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Zip | 60076-2408
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Country | US
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Telephone | 773-616-5330
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Fax |
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Authorized Official
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Title or Position | NURSE PRACITITIONER
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Name | DESIREE CUNNINGHAM
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Credential | NP
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Telephone | 773-616-5330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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