Provider Demographics
NPI:1134505704
Name:BRIDGING LIVES LLC
Entity Type:Organization
Organization Name:BRIDGING LIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-841-3513
Mailing Address - Street 1:12416 PRAIRIE WIND TRL
Mailing Address - Street 2:
Mailing Address - City:RANCHO BELAGO
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5405
Mailing Address - Country:US
Mailing Address - Phone:909-984-3513
Mailing Address - Fax:951-924-7334
Practice Address - Street 1:3081 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5324
Practice Address - Country:US
Practice Address - Phone:951-658-5436
Practice Address - Fax:951-658-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336425538310400000X
CA336425852310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility