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General NPI Number Information
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NPI Number | 1508114786
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Entity Type | Organization
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Legal Business Name | LIFE BRIDGE, LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 1664 SW 28TH ST
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City | TOPEKA
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State | KS
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Zip | 66611-1673
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Country | US
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Telephone | 785-806-3973
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Fax |
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Provider Business Mailing Address
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Address Line | 1664 SW 28TH ST
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City | TOPEKA
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State | KS
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Zip | 66611-1673
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Country | US
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Telephone | 785-806-3973
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Fax |
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Authorized Official
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Title or Position | RN/DIRECTOR
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Name | MRS. ERICA ELIZABETH KOONTZ
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Credential | RN
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Telephone | 785-806-3973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 13-109274-012
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License Number State | KS
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