Provider Demographics
NPI:1205381423
Name:3 BRIDGES RURAL HOMECARE LLC
Entity Type:Organization
Organization Name:3 BRIDGES RURAL HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-719-3558
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:ARK
Mailing Address - State:VA
Mailing Address - Zip Code:23003-0169
Mailing Address - Country:US
Mailing Address - Phone:804-824-2319
Mailing Address - Fax:
Practice Address - Street 1:6549 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-6103
Practice Address - Country:US
Practice Address - Phone:804-824-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171503251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health