Bridge 2 Life-Addison, LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

BRIDGE 2 LIFE-ADDISON, LLC

Doing business as

Panda Way

Practice address

1331 Addison Way
Perris, CA 92571-3878

Phone

(951) 928-0494

NPI assigned

Nov 3, 2011

Organization subpart

No

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

Authorized official

Name

Vivian Bazley

Title

Vice President

Phone

(951) 928-0494

Specialties & licenses 1

Addresses

Other names 1

• PANDA WAY Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1598042608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2551",
            "city": "GUASTI",
            "state": "CA",
            "postal_code": "917432551",
            "telephone_number": "951-928-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 ADDISON WAY",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925713878",
            "telephone_number": "951-928-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE 2 LIFE-ADDISON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "BAZLEY",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "951-928-0494"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PANDA WAY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roswitha Elisabeth Breuer, MD
• Almond Brewer
• Jonathon Michael Brewer
• Bridge 2 Life - El Nido, LLC
• Bridge 2 Life Healthcare, Inc.
• Kelli Brower, LCSW
• Camille T Brown
• Nikisha Simone Brown, LCSW
• Rahsheeda Brown, LVN
• Raven Deshay Brown

• Nursing Facility/Intermediate Care Facility in Perris, CA
• Providers in Perris, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.