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General NPI Number Information
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NPI Number | 1952104622
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Entity Type | Organization
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Legal Business Name | VITA BRIDGE HEALTH LLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 15150 W PARK PL FL 2
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City | GOODYEAR
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State | AZ
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Zip | 85395-2385
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Country | US
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Telephone | 480-207-0296
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Fax | 480-546-3290
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Provider Business Mailing Address
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Address Line | 15150 W PARK PL FL 2
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City | GOODYEAR
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State | AZ
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Zip | 85395-2385
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Country | US
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Telephone | 480-207-0296
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Fax |
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Authorized Official
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Title or Position | RN/PMHNP
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Name | OLAJUMOKE JONGBO
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Credential |
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Telephone | 480-207-0296
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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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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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