Organization
LIFEHOUSE BRIDGE GROUP, LLC
Active
Other names
Lifehouse Bridge Group, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE FULLER (MEMBER)
(847) 839-1525
Entity
Organization
Contact information
Practice address
14127 LEAVITT AVE, BLUE ISLAND, IL 60406-3242
(847) 839-1525
Mailing address
412 LAUDER LN, INVERNESS, IL 60067-4562
(184) 839-1525
(847) 310-1239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/09/2021
Last updated
02/09/2021
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