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General NPI Number Information
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NPI Number | 1730724030
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Entity Type | Organization
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Legal Business Name | THE BRIDGE PRIVATE HOMECARE SERVICES
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Dates
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Enumeration Date | 11/10/2019
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Last Update Date | 11/10/2019
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Provider Practice Location Address
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Address Line | 48 HONEYSUCKLE RIDGE RD SE
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City | ROME
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State | GA
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Zip | 30161-8524
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Country | US
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Telephone | 706-506-0782
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E 2ND AVE STE 300
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City | ROME
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State | GA
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Zip | 30161-3193
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YASHIKA PITTS
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Credential |
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Telephone | 706-506-0782
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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 |
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License Number State |
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