Healthcare Provider Details

I. General information

NPI: 1043621295
Provider Name (Legal Business Name): BRIDGES COMMUNITY SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL 229
ORLANDO FL
32805-3118
US

IV. Provider business mailing address

750 S ORANGE BLOSSOM TRL 229
ORLANDO FL
32805-3118
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-5022
  • Fax:
Mailing address:
  • Phone: 407-745-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: OMUSI RANGER
Title or Position: CEO
Credential:
Phone: 407-683-2894