MEDICARE: THE BRIDGE 14-6 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1598620411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BRIDGE 14-6 LLC

Provider Business Mailing Address
First Line	:	9932 PRINCE ROYAL PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9932 PRINCE ROYAL PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1153
Country	:	US
Telephone Number	:	484-686-2032
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SERGE OWONA
Credential	:
Telephone Number	:	484-686-2032

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “THE BRIDGE 14-6 LLC ” Practice Location

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