MEDICARE: NEW BRIDGE HOMES LLC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1184488462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BRIDGE HOMES LLC

Provider Business Mailing Address
First Line	:	1500 1ST AVE NE STE 219
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55906-4170
Country	:	US
Telephone Number	:	507-884-7103
Fax Number	:	323-978-1943

Provider Business Practice Location Address
First Line	:	2847 KNOLLWOOD DR SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-5975
Country	:	US
Telephone Number	:	507-884-7103
Fax Number	:	323-978-1943

Authorized Official
Title or Position	:	OWNER
Name	:	SADIA HASAN
Credential	:	RN
Telephone Number	:	507-884-7103

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/26/2024

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Directions to “NEW BRIDGE HOMES LLC ” Practice Location

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