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General NPI Number Information
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NPI Number | 1598951931
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Entity Type | Organization
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Legal Business Name | COMMUNITY BRIDGES MANAGEMENT, INC.
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 31 OAKLAND AVE 1ST FLOOR, SUITE E
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City | PONTIAC
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State | MI
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Zip | 48342-2019
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Country | US
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Telephone | 734-347-1462
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Fax | 810-458-4187
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | LINDEN
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State | MI
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Zip | 48451-0489
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Country | US
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Telephone | 734-347-1462
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Fax | 810-458-4187
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Authorized Official
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Title or Position | OWNER/ADMINSITRATOR
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Name | DR. IBRAHAM I. AHMED
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Credential | PH.D, R.N.
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Telephone | 734-347-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301021837
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License Number State | MI
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