Provider Demographics
NPI:1598951931
Name:COMMUNITY BRIDGES MANAGEMENT, INC.
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES MANAGEMENT, INC.
Other - Org Name:COMMUNITY BRIDGES INTEGRATED & SENIOR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINSITRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RN
Authorized Official - Phone:734-347-1462
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0489
Mailing Address - Country:US
Mailing Address - Phone:734-347-1462
Mailing Address - Fax:810-458-4187
Practice Address - Street 1:31 OAKLAND AVE
Practice Address - Street 2:1ST FLOOR, SUITE E
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2019
Practice Address - Country:US
Practice Address - Phone:734-347-1462
Practice Address - Fax:810-458-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301021837208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08-0-B5-1547-0OtherBC/BS
MI11285679OtherCAQH
MI4944183Medicaid
MI08-0-B5-1547-0OtherBC/BS