Provider Demographics
NPI:1053017897
Name:HOME BRIDGE LLC
Entity type:Organization
Organization Name:HOME BRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-300-5820
Mailing Address - Street 1:14946 QUINTANA ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14946 QUINTANA ST NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6644
Practice Address - Country:US
Practice Address - Phone:763-300-5820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39283Medicaid