MEDICARE: BUILDING BRIDGES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1457166076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BRIDGES LLC

Provider Business Mailing Address
First Line	:	501 SW 3RD ST
Second Line	:
City	:	FRUITLAND
State	:	ID
Zip	:	83619-7000
Country	:	US
Telephone Number	:	775-686-3343
Fax Number	:

Provider Business Practice Location Address
First Line	:	5071 HIGHWAY 72
Second Line	:
City	:	NEW PLYMOUTH
State	:	ID
Zip	:	83655-5238
Country	:	US
Telephone Number	:	775-686-3343
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANINE GRUND
Credential	:
Telephone Number	:	775-686-3343

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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Directions to “BUILDING BRIDGES LLC ” Practice Location

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