Provider Demographics
NPI:1659182673
Name:JD'S BRIDGE OF HOPE
Entity type:Organization
Organization Name:JD'S BRIDGE OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-283-4939
Mailing Address - Street 1:15220 KOYLE CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AR
Mailing Address - Zip Code:72959-9062
Mailing Address - Country:US
Mailing Address - Phone:479-283-4939
Mailing Address - Fax:870-782-2874
Practice Address - Street 1:15220 KOYLE CEMETERY RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AR
Practice Address - Zip Code:72959-9062
Practice Address - Country:US
Practice Address - Phone:479-283-4939
Practice Address - Fax:870-782-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health