Healthcare Provider Details

I. General information

NPI: 1194676189
Provider Name (Legal Business Name): BRIDGE WAY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 AVENUE O SW
WINTER HAVEN FL
33880-3925
US

IV. Provider business mailing address

221 AVENUE O SW
WINTER HAVEN FL
33880-3925
US

V. Phone/Fax

Practice location:
  • Phone: 863-399-5822
  • Fax:
Mailing address:
  • Phone: 863-399-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LAKEISHA CHANTA JONES
Title or Position: PRESIDENT
Credential:
Phone: 863-399-5822