Active NPI
Family Bridge Healthcare Services, LLC
- Home Health Agency
- Jonesboro, GA
National Provider Identifier
1003963778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 031R0035
- Legal business name
- FAMILY BRIDGE HEALTHCARE SERVICES, LLC
- Practice address
- 118 North Ave
Suite H
Jonesboro, GA 30236-8405 - Phone
- (770) 473-4600
- Fax
- (770) 473-4100
- NPI assigned
- Jan 4, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Cordelia O Okwandu, BBA, MA, CNA
- Title
- Program Director
- Phone
- (770) 473-4600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 031R0035 | GA | Primary |
Addresses
Primary practice location
118 North Ave
Suite H
Jonesboro, GA 30236-8405
Mailing address
118 North Ave
Suite H
Jonesboro, GA 30236-8405
Phone (770) 473-4600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102676361A | Medicaid | GA | |
| 102676361B | Medicaid | GA |
National Provider Directory
National Provider Directory- Tax ID family
- Family Bridge Healthcare Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- San Antonio, TX
- NPI 1487043741
Locations
118 North Ave
Ste H
Jonesboro, GA 30236
Phone (770) 473-4600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1279584000000",
"number": "1003963778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 NORTH AVE",
"address_2": "SUITE H",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302368405",
"telephone_number": "770-473-4600",
"fax_number": "770-473-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 NORTH AVE",
"address_2": "SUITE H",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302368405",
"telephone_number": "770-473-4600",
"fax_number": "770-473-4100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY BRIDGE HEALTHCARE SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-04",
"last_updated": "2010-07-20",
"status": "A",
"authorized_official_last_name": "OKWANDU",
"authorized_official_first_name": "CORDELIA",
"authorized_official_middle_name": "O",
"authorized_official_title_or_position": "PROGRAM DIRECTOR",
"authorized_official_telephone_number": "770-473-4600",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "BBA, MA, CNA"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "GA",
"license": "031R0035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102676361A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102676361B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.