Provider Demographics
NPI:1497420491
Name:BRIDGE FOR THE LIFE HEALTH SERVICE LLC
Entity Type:Organization
Organization Name:BRIDGE FOR THE LIFE HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREGRIN DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-290-8195
Mailing Address - Street 1:5040 NW 7TH ST STE 660
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3485
Mailing Address - Country:US
Mailing Address - Phone:786-730-3120
Mailing Address - Fax:786-866-2801
Practice Address - Street 1:5040 NW 7TH ST STE 660
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3485
Practice Address - Country:US
Practice Address - Phone:786-730-3120
Practice Address - Fax:786-866-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management