Provider Demographics
NPI:1952986408
Name:A BRIDGE OF HOPE, LLC
Entity Type:Organization
Organization Name:A BRIDGE OF HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAM' MEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-SAS-DMFT
Authorized Official - Phone:262-330-9528
Mailing Address - Street 1:PO BOX 13112
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-0112
Mailing Address - Country:US
Mailing Address - Phone:262-330-9528
Mailing Address - Fax:
Practice Address - Street 1:3614 N 85TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2813
Practice Address - Country:US
Practice Address - Phone:608-598-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty