Provider Demographics
NPI:1073733812
Name:FOSTERBRIDGE, INC.
Entity Type:Organization
Organization Name:FOSTERBRIDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-609-3893
Mailing Address - Street 1:700 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1314
Mailing Address - Country:US
Mailing Address - Phone:740-609-3893
Mailing Address - Fax:740-609-3897
Practice Address - Street 1:700 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1314
Practice Address - Country:US
Practice Address - Phone:740-609-3893
Practice Address - Fax:740-609-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH972743251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH411557Medicaid