Provider Demographics
NPI:1689867467
Name:BRIDGES FOR L.I.F.E. INC
Entity Type:Organization
Organization Name:BRIDGES FOR L.I.F.E. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-517-3406
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 BELLVUE AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-0334
Practice Address - Country:US
Practice Address - Phone:901-517-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty