Healthcare Provider Details

I. General information

NPI: 1346003944
Provider Name (Legal Business Name): BRIDGECARE ABA GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 WASHINGTON ST NW
GAINESVILLE GA
30501-3514
US

IV. Provider business mailing address

3600 STATE ROUTE 66 STE 150
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 201-676-2579
  • Fax: 201-676-2580
Mailing address:
  • Phone: 201-676-2579
  • Fax: 201-676-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI POMERANTZ
Title or Position: CO-FOUNDER
Credential:
Phone: 201-676-2579