Provider Demographics
NPI:1770257412
Name:BRIDGE OF CARE LLC
Entity Type:Organization
Organization Name:BRIDGE OF CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIAR RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:305-603-7063
Mailing Address - Street 1:11401 SW 40TH ST STE 345
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3372
Mailing Address - Country:US
Mailing Address - Phone:305-603-7063
Mailing Address - Fax:305-603-8705
Practice Address - Street 1:2311 10TH AVE N STE 3
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6605
Practice Address - Country:US
Practice Address - Phone:561-899-3017
Practice Address - Fax:561-429-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105068600Medicaid