Active NPI
Life Bridges, Inc
- Family Medicine Physician
- Cleveland, TN
National Provider Identifier
1700928876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- LIFE BRIDGES, INC
- Practice address
- 764 Old Chattanooga PK.
Cleveland, TN 37311 - Phone
- (423) 472-5268
- Fax
- (423) 479-1492
- NPI assigned
- Feb 13, 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
- Mrs. Diana Jackson
- Title
- Chief Executive Officer
- Phone
- (423) 472-5268
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC0000000617 | TN | |
| Behavior Analyst | 103K00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Public Health & General Preventive Medicine Physician | 2083P0901X | |||
| Neurology Physician | 2084N0400X | 20193 | TN | |
| Occupational Therapist | 225X00000X | OT2755 | TN | |
| Non-emergency Medical Transport (VAN) | 343900000X | |||
| Physician Assistant | 363A00000X | 1509 | TN |
Addresses
Primary practice location
764 Old Chattanooga PK.
Cleveland, TN 37311
Mailing address
PO Box 29
Cleveland, TN 37364-0029
Phone (423) 472-5268
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080520000387 | TN | Part B Supplier - Clinic/Group Practice | 8628147410 |
Receives reassigned benefits from 8 practitioners Practice locations: Cleveland, TN |
National Provider Directory
National Provider DirectoryLocations
940 S Ocoee St
Cleveland, TN 37311
Phone (423) 479-5454
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Occupational Therapist
- Cleveland, TN
- NPI 1780843862
-
- Student in an Organized Health Care Education/Training Program
- Cleveland, TN
- NPI 1508909599
TN
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1748995200000",
"number": "1700928876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 29",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373640029",
"telephone_number": "423-472-5268",
"fax_number": "423-479-1492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "764 OLD CHATTANOOGA PK.",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "37311",
"telephone_number": "423-472-5268",
"fax_number": "423-479-1492"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIFE BRIDGES, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-13",
"last_updated": "2025-06-04",
"certification_date": "2025-06-04",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "DIANA",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "423-472-5268",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "LPC0000000617",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "2083P0901X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TN",
"license": "20193",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": "TN",
"license": "OT2755",
"primary": false
},
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "TN",
"license": "1509",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.