Healthcare Provider Details

I. General information

NPI: 1043612344
Provider Name (Legal Business Name): BRIDGES COMMUNITY SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 ANDRUS AVE STE C
ORLANDO FL
32810-5456
US

IV. Provider business mailing address

5222 ANDRUS AVE STE C
ORLANDO FL
32810-5456
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-5022
  • Fax: 407-601-4302
Mailing address:
  • Phone: 407-745-5022
  • Fax: 407-601-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0106165
License Number StateFL

VIII. Authorized Official

Name: OMUSI RANGER
Title or Position: CEO
Credential:
Phone: 407-745-5022