MEDICARE: BRIDGING THE GAP FAMILY 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1679437917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	5625 SABLE BAY PT
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8812
Country	:	US
Telephone Number	:	470-213-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 SABLE BAY PT
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8812
Country	:	US
Telephone Number	:	470-213-1919
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANGER
Name	:	MICHELLE NICHOLS
Credential	:
Telephone Number	:	470-213-1919

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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