Provider Demographics
NPI:1477096139
Name:BRIDGE MANOR LIVING
Entity Type:Organization
Organization Name:BRIDGE MANOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-355-0810
Mailing Address - Street 1:19400 W BELLFORT ST APT 1127
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8202
Mailing Address - Country:US
Mailing Address - Phone:713-355-0810
Mailing Address - Fax:
Practice Address - Street 1:19400 W BELLFORT ST APT 1127
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8202
Practice Address - Country:US
Practice Address - Phone:713-355-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency