Provider Demographics
NPI:1033517859
Name:BRIDGE OF HOPE PROVIDER AGENCY LLC
Entity Type:Organization
Organization Name:BRIDGE OF HOPE PROVIDER AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-5620
Mailing Address - Street 1:2905 CAMERON ST STE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3791
Mailing Address - Country:US
Mailing Address - Phone:318-325-5620
Mailing Address - Fax:318-325-5661
Practice Address - Street 1:2905 CAMERON ST STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3791
Practice Address - Country:US
Practice Address - Phone:318-325-5620
Practice Address - Fax:318-325-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care