Provider Demographics
NPI:1376878538
Name:BRIDGE HOUSE, INC.
Entity Type:Organization
Organization Name:BRIDGE HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWASARAT-LOSALIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-322-3305
Mailing Address - Street 1:PO BOX 2489
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2489
Mailing Address - Country:US
Mailing Address - Phone:808-322-3305
Mailing Address - Fax:808-322-0809
Practice Address - Street 1:79-7266 MAMALAHOA HWY STE 10
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7919
Practice Address - Country:US
Practice Address - Phone:808-322-3305
Practice Address - Fax:808-322-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health