Provider Demographics
NPI:1144561788
Name:BRIDGE OF LIFE HOSPICE, INC
Entity Type:Organization
Organization Name:BRIDGE OF LIFE HOSPICE, INC
Other - Org Name:BRIDGE OF LIFE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILES
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-912-9688
Mailing Address - Street 1:9331 BARTLETT FLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3515
Mailing Address - Country:US
Mailing Address - Phone:210-912-9688
Mailing Address - Fax:210-231-0440
Practice Address - Street 1:152 ZAMORA MEDICAL CIR STE 7
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5919
Practice Address - Country:US
Practice Address - Phone:210-912-9688
Practice Address - Fax:210-231-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health