Healthcare Provider Details

I. General information

NPI: 1114542800
Provider Name (Legal Business Name): BRIDGING THE GAP HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 10TH AVE W UNIT 91
PALMETTO FL
34221-3796
US

IV. Provider business mailing address

1020 10TH AVE W UNIT 91
PALMETTO FL
34221-3796
US

V. Phone/Fax

Practice location:
  • Phone: 209-815-8468
  • Fax: 888-472-6577
Mailing address:
  • Phone: 209-815-8468
  • Fax: 888-472-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: PHEBE SIMMONS
Title or Position: TREASURER
Credential:
Phone: 209-815-8468