Provider Demographics
NPI:1346631017
Name:BRIDGE HEALTHCARE INC
Entity Type:Organization
Organization Name:BRIDGE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:TEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-750-0045
Mailing Address - Street 1:210 RIGGS RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2410
Mailing Address - Country:US
Mailing Address - Phone:202-635-0080
Mailing Address - Fax:202-635-0085
Practice Address - Street 1:210 RIGGS RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2410
Practice Address - Country:US
Practice Address - Phone:202-635-0080
Practice Address - Fax:202-635-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC=========Medicaid