Provider Demographics
NPI:1871356964
Name:BRIDGINGLYFEHEALTH INC
Entity type:Organization
Organization Name:BRIDGINGLYFEHEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:IONA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-855-0783
Mailing Address - Street 1:20280 GOVERNORS HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1068
Mailing Address - Country:US
Mailing Address - Phone:708-734-5255
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST APT 3H
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1770
Practice Address - Country:US
Practice Address - Phone:708-734-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356801206001Medicaid