Provider Demographics
NPI:1518411040
Name:BRIDGING LIVES LLC
Entity Type:Organization
Organization Name:BRIDGING LIVES LLC
Other - Org Name:HORTENSIA VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-841-3513
Mailing Address - Street 1:12416 PRAIRIE WIND TRL
Mailing Address - Street 2:
Mailing Address - City:RANCHO BELAGO
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5405
Mailing Address - Country:US
Mailing Address - Phone:909-841-3513
Mailing Address - Fax:951-924-7334
Practice Address - Street 1:26112 AVENIDA HORTENSIA
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6547
Practice Address - Country:US
Practice Address - Phone:951-927-6276
Practice Address - Fax:951-924-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336426462310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility