Provider Demographics
NPI:1184378747
Name:A BRIDGE 2 WELLNESS LLC
Entity type:Organization
Organization Name:A BRIDGE 2 WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-556-7154
Mailing Address - Street 1:4822 ALBEMARLE RD STE 101P
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6630
Mailing Address - Country:US
Mailing Address - Phone:980-556-7154
Mailing Address - Fax:980-330-4170
Practice Address - Street 1:4822 ALBEMARLE RD STE 101P
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6630
Practice Address - Country:US
Practice Address - Phone:980-556-7154
Practice Address - Fax:980-330-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care