NPIMap

Organization Active NPI

Bridge Hospice, LLC

Doing business as Bridge Hospice

  • Community Based Hospice Care Agency
  • San Diego, CA
National Provider Identifier
1396173597
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BRIDGE HOSPICE, LLC
Doing business as
Bridge Hospice
Practice address
5090 Shoreham PL Ste 209
San Diego, CA 92122-5935
Phone
(582) 775-2008
NPI assigned
Oct 24, 2013
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeff Mongonia
Title
Ceo
Phone
(858) 251-4242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

5090 Shoreham PL Ste 209
San Diego, CA 92122-5935

Mailing address

3636 Nobel Dr Ste 450
San Diego, CA 92122-1062
Phone (858) 251-4242

Other identifiers 2

IdentifierTypeStateIssuer
4635898332OtherCAHOSPICE
75-1568MedicaidCA

Other names 1

  • Bridge Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140220000136 CA Part A Provider - Hospice 1254561160 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396173597. Details of each certification follow.

Hospice certification: CCN 751568

Legal name
BRIDGE HOSPICE, LLC
Doing business as
BRIDGE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 10, 2014
Last certification
Mar 2, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Oct 23, 2013 in CA
Enrollment address
5090 Shoreham PL
Ste 209
San Diego, CA 92122-5935

Care Compare: Hospice

Medicare Care Compare
Listed as
Bridge HospiceCCN 751568 · All quality measures
Ownership
For-Profit
Certified
Nov 10, 2014
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2078742Bridge Hospice, LLC5090 Shoreham PL, Ste 209, San Diego, CA 92122Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory

Locations

200 S Main St
Ste 308
Corona, CA 92882
Phone (951) 270-0800

5090 Shoreham Pl
Ste 212
San Diego, CA 92122
Phone (858) 277-5200

5125 Convoy St
Ste 310
San Diego, CA 92111
Phone (858) 457-1733

6390 Greenwich Dr
Ste 185
San Diego, CA 92122
Phone (619) 453-5994

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nina Marie Cruz Individual Contracted Managing EmployeeAd;DPCS Designee Nov 17, 2025
Operational/Managerial ControlAdministrator & DPCS Designee Nov 17, 2025
Andrew Imparato Individual Contracted Managing EmployeeMD; Feb 1, 2026
Bridge Group Holdco LLC Organization, San Diego, CA Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 7, 2020 100%
Vincent Castaldo Individual Corporate OfficerCfo May 29, 2024
Ahp HH&H Holdco LLC Organization, New York, NY Created for acquisition, LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 31, 2023 82.8%
Jeffrey W Mongonia Individual Corporate OfficerCeo Apr 14, 2023
Jennifer L Prouty Boertje Individual Contracted Managing EmployeeAdministrator Designee & DPCS Dec 31, 2024
Operational/Managerial ControlAdministrator Designee & DPCS Dec 31, 2024
Bridge Group HH Inc Organization, San Diego, CA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 7, 2020 100%
Operational/Managerial Control Feb 7, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1396173597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 NOBEL DR STE 450",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921221062",
            "telephone_number": "858-251-4242",
            "fax_number": "858-408-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5090 SHOREHAM PL STE 209",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225935",
            "telephone_number": "582-775-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "MONGONIA",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-251-4242"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPICE",
            "identifier": "4635898332",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75-1568",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.