=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497420491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGE FOR THE LIFE HEALTH SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2021
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5040 NW 7TH ST STE 660
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-3485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-900-2361
-----------------------------------------------------
Fax | 305-900-2371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5040 NW 7TH ST STE 660
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-3485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-900-2361
-----------------------------------------------------
Fax | 305-900-2371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CELIA GUERRA SUAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-900-2361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------