Healthcare Provider Details

I. General information

NPI: 1215682174
Provider Name (Legal Business Name): BRIDGING THE GAP ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 TALBOTTON RD STE C
COLUMBUS GA
31904-8851
US

IV. Provider business mailing address

909 TALBOTTON RD STE C
COLUMBUS GA
31904-8851
US

V. Phone/Fax

Practice location:
  • Phone: 706-780-1024
  • Fax: 706-505-1128
Mailing address:
  • Phone: 706-780-1024
  • Fax: 706-505-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGINA CRAWFORD
Title or Position: RN/DIRECTOR
Credential: RN
Phone: 334-560-6345