=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467047084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGING INDEPENDENCE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2021
-----------------------------------------------------
Last Update Date | 03/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11183 ASHLEE BROOK DR
-----------------------------------------------------
City | BEALETON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22712-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-409-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11183 ASHLEE BROOK DR
-----------------------------------------------------
City | BEALETON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22712-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-409-9171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. SHERYL MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-409-9171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------