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Organization
BRIDGE OF LIGHT
Active
Organization
BRIDGE OF LIGHT
Active
Other names
Bridge of Light LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. XANDER DANIEL FAISON (OWNER)
(405) 568-1338
Entity
Organization
Contact information
Practice address
14300 N PENNSYLVANIA AVE APT 326, OKLAHOMA CITY, OK 73134-6063
(405) 568-1338
Mailing address
14300 N PENNSYLVANIA AVE APT 326, OKLAHOMA CITY, OK 73134-6063
(405) 568-1338
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
Other
Enumeration date
02/05/2022
Last updated
05/03/2022
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