Provider Demographics
NPI:1114600749
Name:COMMUNITY BRIDGES SOUTH, INC.
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:205-712-1381
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0715
Mailing Address - Country:US
Mailing Address - Phone:318-255-9137
Mailing Address - Fax:
Practice Address - Street 1:2515 BROWNLEE RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2011
Practice Address - Country:US
Practice Address - Phone:318-255-9137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY BRIDGES SOUTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities