Provider Demographics
NPI:1548425697
Name:COMMUNITY BRIDGE HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY BRIDGE HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKHAROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-908-1717
Mailing Address - Street 1:1425 W. PIONEER DR
Mailing Address - Street 2:SUITE 142
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061
Mailing Address - Country:US
Mailing Address - Phone:972-259-2097
Mailing Address - Fax:972-259-2064
Practice Address - Street 1:1425 W PIONEER DR
Practice Address - Street 2:SUITE 142
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7146
Practice Address - Country:US
Practice Address - Phone:972-259-2097
Practice Address - Fax:972-259-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001029188Medicaid