Provider Demographics
NPI:1649091976
Name:LIFEBRIDGE HEALTHCARE LLC
Entity type:Organization
Organization Name:LIFEBRIDGE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRIIBWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-615-0337
Mailing Address - Street 1:111 HILL ST APT 11
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3734
Mailing Address - Country:US
Mailing Address - Phone:857-615-0337
Mailing Address - Fax:
Practice Address - Street 1:111 HILL ST APT 11
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3734
Practice Address - Country:US
Practice Address - Phone:857-615-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care