Provider Demographics
NPI:1568880839
Name:BRIDGE OF HOPE HOSPICE AND PALLIATIVE CARE INC
Entity Type:Organization
Organization Name:BRIDGE OF HOPE HOSPICE AND PALLIATIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-369-0779
Mailing Address - Street 1:4046 HIGHWAY 154
Mailing Address - Street 2:220
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2330
Mailing Address - Country:US
Mailing Address - Phone:404-369-0779
Mailing Address - Fax:
Practice Address - Street 1:4046 HIGHWAY 154
Practice Address - Street 2:220
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2330
Practice Address - Country:US
Practice Address - Phone:404-369-0779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based