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General NPI Number Information
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NPI Number | 1215650817
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Entity Type | Organization
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Legal Business Name | BRIDGING INDEPENDENCE & GROWTH RESOURCES, LLC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 4800 N US HIGHWAY 281
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City | BURNET
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State | TX
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Zip | 78611-5943
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Country | US
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Telephone | 512-773-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N US HIGHWAY 281
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City | BURNET
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State | TX
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Zip | 78611-5943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOHNATHON SHAW
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Credential |
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Telephone | 469-613-7418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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