| Bridge Home | |
|
100 Sunset Ave Venice CA 90291-2517 | |
| (310) 392-8630 | |
| Not Available |
| Full Name | Bridge Home |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 100 Sunset Ave, Venice, California |
| Authorized Official Name and Position | Mitesh G Popat (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3106647901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Home 604 Rose Ave Venice CA 90291-2767 Ph: (310) 392-8630 | Bridge Home 100 Sunset Ave Venice CA 90291-2517 Ph: (310) 392-8630 |
| NPI Number | 1083293948 |
|---|---|
| Provider Enumeration Date | 04/06/2021 |
| Last Update Date | 09/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083293948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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