Provider Demographics
NPI:1942013974
Name:A&O BRIDGE TO INDENPENDENCE
Entity type:Organization
Organization Name:A&O BRIDGE TO INDENPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLORE
Authorized Official - Middle Name:LUZAYISU
Authorized Official - Last Name:VEDIKONDELE
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:603-262-0246
Mailing Address - Street 1:611 SOMERVILLE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4531
Mailing Address - Country:US
Mailing Address - Phone:603-840-9449
Mailing Address - Fax:
Practice Address - Street 1:611 SOMERVILLE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4531
Practice Address - Country:US
Practice Address - Phone:603-840-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care