Lifehouse Bridge Group, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LIFEHOUSE BRIDGE GROUP, LLC

Practice address

14127 Leavitt Ave
Blue Island, IL 60406-3242

Phone

(847) 839-1525

NPI assigned

Feb 9, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Jesse Fuller

Title

Member

Phone

(847) 839-1525

Specialties & licenses 1

Addresses

Other names 1

• Lifehouse Bridge Group, LLC Former legal business name

Electronic endpoints 6

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1760074991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 LAUDER LN",
            "city": "INVERNESS",
            "state": "IL",
            "postal_code": "600674562",
            "telephone_number": "184-839-1525",
            "fax_number": "847-310-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14127 LEAVITT AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604063242",
            "telephone_number": "847-839-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEHOUSE BRIDGE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-839-1525",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "ADDRESS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "ADDRESS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "COMPUTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "MOBIL",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "ADDRESS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "ADDRESS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPUTER",
            "affiliation": "N",
            "endpointDescription": "COMPUTER",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "MOBIL",
            "address_1": "14127 Leavitt Ave",
            "city": "Blue Island",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604063242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lifehouse Bridge Group, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Brenda Lee Langford, MSN, APRN, FNP-C
• Leo W Lavender
• Carrie L Lewis, CNA
• Christel Lewis
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• Martin Francis Lowery, D.D.S.
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• Community/Behavioral Health Agency in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.