Provider Demographics
NPI:1043049414
Name:BRIDGE 2 PEACE HOME CARE LLC
Entity type:Organization
Organization Name:BRIDGE 2 PEACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ADMIN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-429-6630
Mailing Address - Street 1:83 CORTESE LN
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-2916
Mailing Address - Country:US
Mailing Address - Phone:404-429-6630
Mailing Address - Fax:
Practice Address - Street 1:83 CORTESE LN
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-2916
Practice Address - Country:US
Practice Address - Phone:404-429-6630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care