Provider Demographics
NPI:1942881776
Name:PONTE VITAE BRIDGE TO LIFE HEALTHCARE INC
Entity Type:Organization
Organization Name:PONTE VITAE BRIDGE TO LIFE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOCHUKWU
Authorized Official - Middle Name:F
Authorized Official - Last Name:OGBUNWEZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-403-1103
Mailing Address - Street 1:180 WALLACE RD APT K11
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4663
Mailing Address - Country:US
Mailing Address - Phone:615-403-1103
Mailing Address - Fax:
Practice Address - Street 1:180 WALLACE RD APT K11
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4663
Practice Address - Country:US
Practice Address - Phone:615-403-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care