Healthcare Provider Details

I. General information

NPI: 1588336887
Provider Name (Legal Business Name): STRENGTHENING THE BRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 E FOUNTAIN ST
MESA AZ
85213-5214
US

IV. Provider business mailing address

2037 E FOUNTAIN ST
MESA AZ
85213-5214
US

V. Phone/Fax

Practice location:
  • Phone: 334-275-7786
  • Fax:
Mailing address:
  • Phone: 334-275-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. NAKIA GRAY
Title or Position: MANAGER/MEMBER
Credential: MA
Phone: 334-275-7786