Provider Demographics
NPI:1982807616
Name:BRIDGES, SAMANTHA A
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 PICKERING LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7056
Mailing Address - Country:US
Mailing Address - Phone:832-661-9376
Mailing Address - Fax:281-489-8156
Practice Address - Street 1:3514 PICKERING LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7056
Practice Address - Country:US
Practice Address - Phone:832-661-9376
Practice Address - Fax:281-489-8156
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities