MEDICARE: HEALING BRIDGE HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1083447577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING BRIDGE HEALTH, INC.

Provider Business Mailing Address
First Line	:	8061 SAINT CLAIR AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1322
Country	:	US
Telephone Number	:	747-271-7001
Fax Number	:	747-271-7009

Provider Business Practice Location Address
First Line	:	8061 SAINT CLAIR AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1322
Country	:	US
Telephone Number	:	747-271-7001
Fax Number	:	747-271-7009

Authorized Official
Title or Position	:	CEO & DIR. OF NURSING
Name	:	MS. ODETTE NJECHEU TOMTA
Credential	:	DNP, CNL, CMSRN, RN
Telephone Number	:	818-398-0950

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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