Provider Demographics
NPI:1831672054
Name:HEALTHBRIDGE MEDICAL AND REHABILITATIVE SERVICES LLC
Entity Type:Organization
Organization Name:HEALTHBRIDGE MEDICAL AND REHABILITATIVE SERVICES LLC
Other - Org Name:HEALTHBRIDGE HOME HEALTH OF ROSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS IAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BICOL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNA
Authorized Official - Phone:575-363-8178
Mailing Address - Street 1:500 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4721
Mailing Address - Country:US
Mailing Address - Phone:575-363-8178
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST STE 530
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4676
Practice Address - Country:US
Practice Address - Phone:575-363-8178
Practice Address - Fax:855-655-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health