Provider Demographics
NPI:1235881103
Name:BRIDGE OF HOPE FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGE OF HOPE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-358-8573
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE C201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3043
Mailing Address - Country:US
Mailing Address - Phone:314-358-8573
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE C201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3043
Practice Address - Country:US
Practice Address - Phone:314-358-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health