Provider Demographics
NPI:1861095986
Name:BRIDGE HOME HEALTH NORTH BAY LLC
Entity type:Organization
Organization Name:BRIDGE HOME HEALTH NORTH BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-453-5994
Mailing Address - Street 1:3636 NOBEL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1062
Mailing Address - Country:US
Mailing Address - Phone:858-251-4242
Mailing Address - Fax:
Practice Address - Street 1:110 STONY POINT RD STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4118
Practice Address - Country:US
Practice Address - Phone:707-340-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health