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General NPI Number Information
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NPI Number | 1952986408
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Entity Type | Organization
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Legal Business Name | A BRIDGE OF HOPE, LLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 3614 N 85TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-2813
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Country | US
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Telephone | 608-598-8963
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13112
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City | MILWAUKEE
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State | WI
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Zip | 53213-0112
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Country | US
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Telephone | 262-330-9528
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TAM' MEKA BERRY
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Credential | MS, LPC-SAS-DMFT
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Telephone | 262-330-9528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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