Provider Demographics
NPI:1831476456
Name:LIFE BRIDGE HOME HEALTH
Entity Type:Organization
Organization Name:LIFE BRIDGE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-622-4991
Mailing Address - Street 1:1302 AIRLIE WAY
Mailing Address - Street 2:SUITE L
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1049
Mailing Address - Country:US
Mailing Address - Phone:443-622-4991
Mailing Address - Fax:410-435-4633
Practice Address - Street 1:8830 ORCHARD TREE LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2143
Practice Address - Country:US
Practice Address - Phone:443-622-4991
Practice Address - Fax:410-435-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health