Healthcare Provider Details

I. General information

NPI: 1427367028
Provider Name (Legal Business Name): BRIDGES OF HOPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N FIR AVE
SILER CITY NC
27344-3712
US

IV. Provider business mailing address

202 E ARLINGTON BLVD STE D
GREENVILLE NC
27858-5021
US

V. Phone/Fax

Practice location:
  • Phone: 919-533-4166
  • Fax:
Mailing address:
  • Phone: 252-321-1621
  • Fax: 252-321-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8303079
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: AMANDA HOPKINS
Title or Position: CEO
Credential:
Phone: 252-321-1621