Provider Demographics
NPI:1174366280
Name:CAREBRIDGETN, LLC
Entity type:Organization
Organization Name:CAREBRIDGETN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-571-2025
Mailing Address - Street 1:3316 CHATEAU CIR N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8117
Mailing Address - Country:US
Mailing Address - Phone:662-571-2025
Mailing Address - Fax:
Practice Address - Street 1:3900 NEW COVINGTON PIKE STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2526
Practice Address - Country:US
Practice Address - Phone:662-571-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care