MEDICARE: BRIDGE HOSPICE, 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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4635898332	OTHER	CA	HOSPICE

General Provider Information

NPI Number	:	1396173597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	3636 NOBEL DR STE 450
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1062
Country	:	US
Telephone Number	:	858-251-4242
Fax Number	:	858-408-3210

Provider Business Practice Location Address
First Line	:	5090 SHOREHAM PL STE 209
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5935
Country	:	US
Telephone Number	:	582-775-2008
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFF MONGONIA
Credential	:
Telephone Number	:	858-251-4242

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	05/24/2023

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