Provider Demographics
NPI:1316756281
Name:FIRM BRIDGE LLC
Entity type:Organization
Organization Name:FIRM BRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA PRILLE
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:MAKUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-770-1897
Mailing Address - Street 1:6053 HUDSON RD, STE 280
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:239-770-1897
Mailing Address - Fax:
Practice Address - Street 1:6053 HUDSON RD, STE 280
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:239-770-1897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty