Provider Demographics
NPI:1083479380
Name:BRIDGE OF HOPE CENTER
Entity Type:Organization
Organization Name:BRIDGE OF HOPE CENTER
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOTHERAPY
Authorized Official - Prefix:
Authorized Official - First Name:SUSSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-773-8673
Mailing Address - Street 1:38 BAYONNE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-8753
Mailing Address - Country:US
Mailing Address - Phone:401-548-9716
Mailing Address - Fax:
Practice Address - Street 1:38 BAYONNE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-8753
Practice Address - Country:US
Practice Address - Phone:401-548-9716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center