1922204296 NPI number — THE BRIDGE CENTER FOR GROWTH, PC.

Table of content: JESSICA MARIE D'ANGELO MS, NP (NPI 1265843692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922204296 NPI number — THE BRIDGE CENTER FOR GROWTH, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BRIDGE CENTER FOR GROWTH, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922204296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE ILE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48138-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-675-9700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23933 ALLEN RD STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-3369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACKER
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-675-9700

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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