Provider Demographics
NPI:1043729858
Name:BRIDGE OF HOPE COUNSELING PCA
Entity Type:Organization
Organization Name:BRIDGE OF HOPE COUNSELING PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-464-5080
Mailing Address - Street 1:5258 S EASTERN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2327
Mailing Address - Country:US
Mailing Address - Phone:702-464-5080
Mailing Address - Fax:702-262-1399
Practice Address - Street 1:5258 S EASTERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2327
Practice Address - Country:US
Practice Address - Phone:702-464-5080
Practice Address - Fax:702-262-1399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NV201511133773
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health