Healthcare Provider Details

I. General information

NPI: 1275715146
Provider Name (Legal Business Name): BRIDGING THE GAP OF BATON ROUGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 WOODDALE COURT SUITE 303
BATON ROUGE LA
70806-1535
US

IV. Provider business mailing address

1821 WOODDALE COURT SUITE 303
BATON ROUGE LA
70806-1535
US

V. Phone/Fax

Practice location:
  • Phone: 225-926-6978
  • Fax: 225-926-6694
Mailing address:
  • Phone: 225-926-6978
  • Fax: 225-926-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1183806
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1175421
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1184063
License Number StateLA

VIII. Authorized Official

Name: MS. LUCILLE H GILLIAM
Title or Position: DIRECTOR
Credential:
Phone: 225-926-6978