Provider Demographics
NPI:1497071849
Name:BRIDGE OF FAITH HOSPICE & PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:BRIDGE OF FAITH HOSPICE & PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-572-4333
Mailing Address - Street 1:PO BOX 2522
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-0522
Mailing Address - Country:US
Mailing Address - Phone:870-572-4333
Mailing Address - Fax:870-572-4433
Practice Address - Street 1:657 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-1503
Practice Address - Country:US
Practice Address - Phone:870-572-4333
Practice Address - Fax:870-572-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based