Provider Demographics
NPI:1194490201
Name:BRIDGES, DORIS (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 WEST 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114
Mailing Address - Country:US
Mailing Address - Phone:501-379-9480
Mailing Address - Fax:501-379-9480
Practice Address - Street 1:1109 WEST 18TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-379-9480
Practice Address - Fax:501-379-9480
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050161370407E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health