Provider Demographics
NPI:1083326367
Name:BRIDGE OF HOPE MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGE OF HOPE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERHANU
Authorized Official - Middle Name:KEBEDE
Authorized Official - Last Name:BEDASSA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:213-249-6973
Mailing Address - Street 1:13250 NE SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1453
Mailing Address - Country:US
Mailing Address - Phone:213-249-6973
Mailing Address - Fax:
Practice Address - Street 1:13216 SE FOREST STREET,
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:213-249-6973
Practice Address - Fax:503-265-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty