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General NPI Number Information
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NPI Number | 1295365617
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Entity Type | Organization
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Legal Business Name | BRIDGE 4 HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 1379 CAMELIA ST
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City | RIVERDALE
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State | GA
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Zip | 30296-1190
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Country | US
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Telephone | 678-223-8138
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 142614
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-6518
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Country | US
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Telephone | 678-223-8138
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ARLY BRUTUS
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Credential |
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Telephone | 678-223-8138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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