Provider Demographics
NPI:1386473551
Name:GREENBRIDGE HEALTH CLINIC
Entity type:Organization
Organization Name:GREENBRIDGE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOCHI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:708-916-5798
Mailing Address - Street 1:2560 CASA BELLA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-5527
Mailing Address - Country:US
Mailing Address - Phone:708-916-5798
Mailing Address - Fax:
Practice Address - Street 1:4256 W 24TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-7171
Practice Address - Country:US
Practice Address - Phone:509-802-3664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty