Provider Demographics
NPI:1518795483
Name:BRIDGE OF HOPE
Entity type:Organization
Organization Name:BRIDGE OF HOPE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-405-2053
Mailing Address - Street 1:4001 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-3203
Mailing Address - Country:US
Mailing Address - Phone:314-405-2053
Mailing Address - Fax:
Practice Address - Street 1:4001 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3203
Practice Address - Country:US
Practice Address - Phone:314-405-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care