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Organization
VITA BRIDGE HEALTH LLC
Active
Organization
VITA BRIDGE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLAJUMOKE JONGBO (RN/PMHNP)
(480) 207-0296
Entity
Organization
Contact information
Practice address
15150 W PARK PL FL 2, GOODYEAR, AZ 85395-2385
(480) 207-0296
(480) 546-3290
Mailing address
15150 W PARK PL FL 2, GOODYEAR, AZ 85395-2385
(480) 207-0296
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/28/2025
Last updated
04/15/2025
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