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General NPI Number Information
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NPI Number | 1790893675
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Entity Type | Organization
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Legal Business Name | BRIDGE OF LIGHT HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2234 S HAMILTON RD 101
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City | COLUMBUS
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State | OH
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Zip | 43232-4389
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Country | US
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Telephone | 614-751-3730
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Fax | 614-751-4481
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Provider Business Mailing Address
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Address Line | 2234 S HAMILTON RD 101
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City | COLUMBUS
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State | OH
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Zip | 43232-4389
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Country | US
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Telephone | 614-751-3730
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Fax | 614-751-4481
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Authorized Official
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Title or Position | EXCEUTIVE DIRECTOR
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Name | MS. MARY LEE BOSCHULTE
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Credential | N.P.
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Telephone | 614-751-3730
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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 | OH
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