Organization
LIFE BRIDGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA ELIZABETH KOONTZ RN (RN/DIRECTOR)
(785) 806-3973
Entity
Organization
Contact information
Practice address
1664 SW 28TH ST, TOPEKA, KS 66611-1673
(785) 806-3973
Mailing address
1664 SW 28TH ST, TOPEKA, KS 66611-1673
(785) 806-3973
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
13-109274-012
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417227265
NPI # 1417227265
KS
Enumeration date
08/21/2012
Last updated
08/21/2012
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