Healthcare Provider Details

I. General information

NPI: 1780934174
Provider Name (Legal Business Name): BRIDGING BETWEEN GAPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GIBSON RD
BALTIMORE MD
21229-4405
US

IV. Provider business mailing address

620 GIBSON RD
BALTIMORE MD
21229-4405
US

V. Phone/Fax

Practice location:
  • Phone: 410-615-4025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: YOLANDA R BARNES
Title or Position: DIRECTOR
Credential:
Phone: 410-615-4025