Provider Demographics
NPI:1649884537
Name:BRIDGE TO CARE NURSE PRACTITIONER IN PSYCHIATRY PC
Entity type:Organization
Organization Name:BRIDGE TO CARE NURSE PRACTITIONER IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-288-0979
Mailing Address - Street 1:10536 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3018
Mailing Address - Country:US
Mailing Address - Phone:347-627-6100
Mailing Address - Fax:
Practice Address - Street 1:3005 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4209
Practice Address - Country:US
Practice Address - Phone:347-627-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center