Provider Demographics
NPI:1649497280
Name:HEALTH BRIDGE
Entity type:Organization
Organization Name:HEALTH BRIDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:301-538-3700
Mailing Address - Street 1:6118 E. MAIN ST.
Mailing Address - Street 2:SUITE B-103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:301-960-4830
Mailing Address - Fax:301-218-0338
Practice Address - Street 1:6118 E MAIN ST
Practice Address - Street 2:SUITE B-103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8964
Practice Address - Country:US
Practice Address - Phone:301-960-4830
Practice Address - Fax:301-218-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies