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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