| Lifehouse Bridge Group, Llc | |
|
14127 Leavitt Ave Blue Island IL 60406-3242 | |
| (847) 839-1525 | |
| Not Available |
| Full Name | Lifehouse Bridge Group, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14127 Leavitt Ave, Blue Island, Illinois |
| Authorized Official Name and Position | Jesse Fuller (MEMBER) |
| Authorized Official Contact | 8478391525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifehouse Bridge Group, Llc 412 Lauder Ln Inverness IL 60067-4562 Ph: (184) 839-1525 | Lifehouse Bridge Group, Llc 14127 Leavitt Ave Blue Island IL 60406-3242 Ph: (847) 839-1525 |
| NPI Number | 1760074991 |
|---|---|
| Provider Enumeration Date | 02/09/2021 |
| Last Update Date | 02/09/2021 |
| Certification Date | 02/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760074991 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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