Provider Demographics
NPI:1528560034
Name:BRIDGE GROUP INTEGRATED HEALTH CARE SYSTEMS LLC
Entity Type:Organization
Organization Name:BRIDGE GROUP INTEGRATED HEALTH CARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:DELIA
Authorized Official - Last Name:SALDANA-ESPITIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-709-1431
Mailing Address - Street 1:1800 W BROADWAY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 W BROADWAY RD STE 3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1023
Practice Address - Country:US
Practice Address - Phone:480-709-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00000000OtherAHCCCS