MEDICARE: BRIDGING THE GAP RESIDENTIAL SERVICES, 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	310400000X	Assisted Living Facility	MHL-032-451	NC
2	310400000X	Assisted Living Facility	MHL-032-419	NC
3	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-032-520	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568651602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP RESIDENTIAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	2945 S MIAMI BLVD
Second Line	:	SUITE 114
City	:	DURHAM
State	:	NC
Zip	:	27703-8024
Country	:	US
Telephone Number	:	919-641-8378
Fax Number	:	919-964-3364

Provider Business Practice Location Address
First Line	:	2945 S MIAMI BLVD
Second Line	:	SUITE 114
City	:	DURHAM
State	:	NC
Zip	:	27703-8024
Country	:	US
Telephone Number	:	919-641-8378
Fax Number	:	919-964-3364

Authorized Official
Title or Position	:	OWNER
Name	:	MARSHELIA BENTON
Credential	:
Telephone Number	:	919-641-8378

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	04/14/2016

Similar Medicare Providers

1982985958 — MR. JESSE CHARLES MARTIN LPCA
Practice Location Address:

2945 S MIAMI BLVD , SUITE 103
DURHAM, NC
27703-8024

Practice Phone: 919-616-1546
Practice Fax:

1851843932 — EMILY ANNE MACRAE MS BCBA LBA
Practice Location Address:

4819 EMPEROR BLVD STE 400
DURHAM, NC
27703-5420

Practice Phone: 855-832-6727
Practice Fax: 772-675-9100

1609823053 — PRUITTHEALTH PHARMACY SERVICES - DURHAM, INC.
Practice Location Address:

4024 STIRRUP CREEK DR STE 325
DURHAM, NC
27703-9464

Practice Phone: 919-484-2229
Practice Fax:

1366398083 — MRS. DANIELLE ERVIN PT, DPT
Practice Location Address:

808 BACON ST
DURHAM, NC
27703-5006

Practice Phone: 919-560-2000
Practice Fax:

1962744953 — MRS. ANDREA C. BATES LCSW
Practice Location Address:

12425 KENDALL RIDGE CT
DURHAM, NC
27703-8543

Practice Phone: 919-457-8311
Practice Fax:

1053312322 — MR. QUANG HA
Practice Location Address:

5400 S MIAMI BLVD
DURHAM, NC
27703-8465

Practice Phone: 919-941-5549
Practice Fax: 919-941-5569

Directions to “BRIDGING THE GAP RESIDENTIAL SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.