| Bridge Of Care Llc | |
|
11401 Sw 40th St Ste 345 Miami FL 33165-3372 | |
| (305) 603-7063 | |
| (305) 603-8705 |
| Full Name | Bridge Of Care Llc |
|---|---|
| Speciality | Case Management |
| Location | 11401 Sw 40th St Ste 345, Miami, Florida |
| Authorized Official Name and Position | Alain Perez Hernandez (DIRECTOR) |
| Authorized Official Contact | 7863681112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Of Care Llc 11401 Sw 40th St Ste 345 Miami FL 33165-3372 Ph: (306) 603-7063 | Bridge Of Care Llc 11401 Sw 40th St Ste 345 Miami FL 33165-3372 Ph: (305) 603-7063 |
| NPI Number | 1245752062 |
|---|---|
| Provider Enumeration Date | 07/13/2017 |
| Last Update Date | 08/05/2021 |
| Certification Date | 08/05/2021 |
| Medicare PECOS PAC ID | 8628499530 |
|---|---|
| Medicare Enrollment ID | O20200602000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245752062 | NPI | - | NPPES |
| 101485600 | Medicaid | FL | |
| 022283100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | 022283100 (Florida) | Primary |
| Provider Name | Jason Lopez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659802916 PECOS PAC ID: 9335549518 Enrollment ID: I20210609001412 |
| Provider Name | Abel Bueno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124665039 PECOS PAC ID: 6002268026 Enrollment ID: I20240116000930 |
| Provider Name | Francisca S Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306477187 PECOS PAC ID: 8628420858 Enrollment ID: I20240123003482 |
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