Provider Demographics
NPI:1295365617
Name:BRIDGE 4 HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:BRIDGE 4 HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-223-8138
Mailing Address - Street 1:PO BOX 142614
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6518
Mailing Address - Country:US
Mailing Address - Phone:678-223-8138
Mailing Address - Fax:
Practice Address - Street 1:1379 CAMELIA ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1190
Practice Address - Country:US
Practice Address - Phone:678-223-8138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA031-R-1605OtherHEALTHCARE LICENSE NUMBER