MEDICARE: BRIDGE OF LIGHT HEALTH SERVICES 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	251E00000X	Home Health Agency		OH

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

General Provider Information

NPI Number	:	1790893675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE OF LIGHT HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	2234 S HAMILTON RD
Second Line	:	101
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4389
Country	:	US
Telephone Number	:	614-751-3730
Fax Number	:	614-751-4481

Provider Business Practice Location Address
First Line	:	2234 S HAMILTON RD
Second Line	:	101
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4389
Country	:	US
Telephone Number	:	614-751-3730
Fax Number	:	614-751-4481

Authorized Official
Title or Position	:	EXCEUTIVE DIRECTOR
Name	:	MS. MARY LEE BOSCHULTE
Credential	:	N.P.
Telephone Number	:	614-751-3730

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/21/2022

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