Provider Demographics
NPI:1508690744
Name:BRIDGE 2 HOME LLC
Entity type:Organization
Organization Name:BRIDGE 2 HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYSHAWN
Authorized Official - Middle Name:T
Authorized Official - Last Name:EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-647-2676
Mailing Address - Street 1:5229 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1217
Mailing Address - Country:US
Mailing Address - Phone:216-647-2676
Mailing Address - Fax:
Practice Address - Street 1:7231 FORESTWOOD DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5261
Practice Address - Country:US
Practice Address - Phone:216-647-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty