Provider Demographics
NPI:1679068480
Name:BRIDGES OF LOVE, LLC
Entity Type:Organization
Organization Name:BRIDGES OF LOVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-522-1916
Mailing Address - Street 1:1233 E MOUNT PLEASANT RD APT 403
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-5928
Mailing Address - Country:US
Mailing Address - Phone:225-360-8029
Mailing Address - Fax:
Practice Address - Street 1:1233 E MOUNT PLEASANT RD APT 403
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5928
Practice Address - Country:US
Practice Address - Phone:225-360-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health