1144561788 NPI number — BRIDGE OF LIFE HOSPICE, INC

Table of content: (NPI 1144561788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144561788 NPI number — BRIDGE OF LIFE HOSPICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGE OF LIFE HOSPICE, INC
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:
1144561788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9331 BARTLETT FLS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78250-3515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-912-9688
Provider Business Mailing Address Fax Number:
210-231-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 ZAMORA MEDICAL CIR STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-912-9688
Provider Business Practice Location Address Fax Number:
210-231-0440
Provider Enumeration Date:
03/06/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MIRALLES
Authorized Official First Name:
MARILES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
210-912-9688

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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