Provider Demographics
NPI:1770118309
Name:6TH ST. BRIDGE MOBILITY AND HOME CARE LLC
Entity type:Organization
Organization Name:6TH ST. BRIDGE MOBILITY AND HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-223-0000
Mailing Address - Street 1:1205 TECH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7856
Mailing Address - Country:US
Mailing Address - Phone:813-787-8375
Mailing Address - Fax:813-714-7274
Practice Address - Street 1:1205 TECH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7856
Practice Address - Country:US
Practice Address - Phone:813-621-2001
Practice Address - Fax:813-701-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107636400Medicaid