Healthcare Provider Details

I. General information

NPI: 1063280501
Provider Name (Legal Business Name): BRIDGING THE GAP ADC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 TALBOTTON RD STE C
COLUMBUS GA
31904-8851
US

IV. Provider business mailing address

6141 BROOKSTONE BLVD
COLUMBUS GA
31904-2959
US

V. Phone/Fax

Practice location:
  • Phone: 706-780-1024
  • Fax:
Mailing address:
  • Phone: 334-560-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS REGINA CRAWFORD
Title or Position: OWNER
Credential: RN
Phone: 334-560-6345