Healthcare Provider Details

I. General information

NPI: 1588510978
Provider Name (Legal Business Name): FAMILY BRIDGE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 ORLEANS DR
EAGLE LAKE FL
33839-5216
US

IV. Provider business mailing address

5705 WALLIS LN
SAINT CLOUD FL
34771-7627
US

V. Phone/Fax

Practice location:
  • Phone: 407-552-7335
  • Fax:
Mailing address:
  • Phone: 407-552-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA SERENA FREEMAN
Title or Position: OWNER /CEO
Credential:
Phone: 407-552-7335