Provider Demographics
NPI:1922495316
Name:LIFEBRIDGE COMPREHENSIVE SERVICES, INC
Entity Type:Organization
Organization Name:LIFEBRIDGE COMPREHENSIVE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNGHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-631-1034
Mailing Address - Street 1:215-10 NORTHERN BLVD. SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:718-631-1034
Mailing Address - Fax:718-631-1035
Practice Address - Street 1:49-19 FRANCIS LEWIS BLVD. #LL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:718-631-1034
Practice Address - Fax:718-631-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency