Provider Demographics
NPI:1053629915
Name:BRIDGE CARE FOR WOMEN LLC
Entity Type:Organization
Organization Name:BRIDGE CARE FOR WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-661-8000
Mailing Address - Street 1:3500 TRINITY DR
Mailing Address - Street 2:STE C-5
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1775
Mailing Address - Country:US
Mailing Address - Phone:505-661-8000
Mailing Address - Fax:505-661-8001
Practice Address - Street 1:3500 TRINITY DR
Practice Address - Street 2:STE C-5
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-1775
Practice Address - Country:US
Practice Address - Phone:505-661-8000
Practice Address - Fax:505-661-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty