Provider Demographics
NPI:1891394722
Name:TROWBRIDGE A.G. LLC
Entity Type:Organization
Organization Name:TROWBRIDGE A.G. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MR
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BADNJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-505-4675
Mailing Address - Street 1:6880 46TH AVE N STE 240
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4753
Mailing Address - Country:US
Mailing Address - Phone:813-505-4675
Mailing Address - Fax:
Practice Address - Street 1:5028 34TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2116
Practice Address - Country:US
Practice Address - Phone:813-505-4675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities