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General NPI Number Information
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NPI Number | 1316756281
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Entity Type | Organization
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Legal Business Name | FIRM BRIDGE LLC
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 6053 HUDSON RD, STE 280
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 239-770-1897
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 HUDSON RD, STE 280
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 239-770-1897
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | BRENDA PRILLE RONALD MAKUNDI
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Credential |
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Telephone | 239-770-1897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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