LIFE BRIDGES, INC. (NPI# 1376847251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376847251 |
| Entity Type | Organization |
| Organization Name | LIFE BRIDGES, INC. |
| Other Organization Name | EDGEMON HOUSE |
| Practice Address |
209 Kile Lake Road Cleveland TN 37323 |
| Mailing Address |
Po Box 29 Cleveland TN 37364-0029 |
| Practice Telephone | 4234725268 |
| Practice Fax Number | 4234791492 |
| Mailing Telephone | 4234725268 |
| Mailing Fax Number | 4234791492 |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2013-03-13 |
| Authorized Official Name | DR. LUCAS QUEEN (CEO) |
| Authorized Official Telephone | 4234725268 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3722363 | 05 |
| Other Name | Type Code |
|---|---|
| Edgemon House | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679877518 | Life Bridges, Inc. | Intermediate Care Facility, Mentally Retarded | 207 Kile Lake Road, Cleveland, TN 37323 | 2011-01-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LIFE BRIDGES, INC. | 764 Old Chattanooga Pike Sw, Cleveland, TN 37311-8517 |
| Street Address |
209 KILE LAKE ROAD |
| City | CLEVELAND |
| State | TN |
| Zip Code | 37323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477066082 | Quadmed Medical Clinics of Wisconsin, S.c. D/b/a Quadmed Medical Group | Registered Nurse | 2525 Benton Pike Ne, Cleveland, TN 37323 | 2017-11-06 |
| 1679877518 | Life Bridges, Inc. | Intermediate Care Facility, Mentally Retarded | 207 Kile Lake Road, Cleveland, TN 37323 | 2011-01-07 |
| 1508084302 | Karen Elizabeth Gannon | Nurse Practitioner | 11111 Doctor's Office Tower, 2200 Children's Way, Nashville, TN 37323 | 2007-04-24 |
| 1235353566 | Melissa D Townsend | Specialist/Technologist, Other | 120 Fern Drive, Cleveland, TN 37323 | 2007-04-11 |
| 1306965686 | David Wayne Miolen | Dentist | 2648 Apd 40, Cleveland, TN 37323 | 2007-03-28 |
| 1780751933 | Linda Fay Wooten | Driver | 2259 Spring Place Rd Se, Cleveland, TN 37323 | 2006-11-30 |
| 1487134482 | Kristy Alese Henegar | Nurse Practitioner | 1420 Fritz St Se, Cleveland, TN 37323 | 2018-08-19 |
| 1417577537 | Eduardo Trevino | Family Medicine | 3009 Midfield Cir Se, Cleveland, TN 37323-0554 | 2020-04-18 |
| 1831339589 | Lyle Foster Johnson | Occupational Therapy Assistant | 2657 Apd 40, Cleveland, TN 37323-0696 | 2009-02-20 |
| 1255434965 | Tennessee Cvs Pharmacy LLC | Pharmacy | 2651 Apd 40, S Forke Plaza, Cleveland, TN 37323-0696 | 2006-09-07 |
| Find all providers in zip 37323 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700201118 | Tamara M Cowans | Intermediate Care Facility, Mentally Retarded | 9409 Easton Ave, Cleveland, OH 44104-5417 | 2014-02-21 |
| 1679877518 | Life Bridges, Inc. | Intermediate Care Facility, Mentally Retarded | 207 Kile Lake Road, Cleveland, TN 37323 | 2011-01-07 |
| 1801001524 | Cuyahoga County Bd. of Mrdd | Intermediate Care Facility, Mentally Retarded | 6809 Smith Rd, Cleveland, OH 44130-2681 | 2007-05-14 |
| 1164636007 | Cuyahoga County Bd. of Mrdd | Intermediate Care Facility, Mentally Retarded | 2440 W 14th St, Cleveland, OH 44113-4406 | 2007-05-10 |
| 1427262369 | Cuyahoga County Bd. of Mrdd | Intermediate Care Facility, Mentally Retarded | 2980 Van Aken Blvd, Cleveland, OH 44120-2862 | 2007-05-10 |
| 1407060684 | Cuyahoga County Bd of Mrdd | Intermediate Care Facility, Mentally Retarded | 1905 Green Rd, Cleveland, OH 44112-1021 | 2007-05-09 |
| 1487868790 | Cuyahoga County Bd of Mrdd | Intermediate Care Facility, Mentally Retarded | 4248 W 35th St, Cleveland, OH 44109-3108 | 2007-05-09 |
| 1336353432 | Cuyahoga County Bd of Mrdd | Intermediate Care Facility, Mentally Retarded | 4520 Monticello Blvd, Cleveland, OH 44143-2840 | 2007-05-09 |
| 1104039924 | Cuyahoga County Bd. of Mrdd | Intermediate Care Facility, Mentally Retarded | 19080 Bagley Rd, Cleveland, OH 44130-3310 | 2007-05-08 |
| 1912121005 | New Avenues To Independence, Inc. | Intermediate Care Facility, Mentally Retarded | 17608 Euclid Ave, Cleveland, OH 44112-1216 | 2007-04-12 |
| Find all providers in CLEVELAND | ||||
Please comment or provide details below to improve the information on LIFE BRIDGES, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.