Healthcare Provider Details

I. General information

NPI: 1881339521
Provider Name (Legal Business Name): BRIDGE TO SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 COAL AVE SE UNIT A
ALBUQUERQUE NM
87108-2907
US

IV. Provider business mailing address

PO BOX 25447
ALBUQUERQUE NM
87125-0447
US

V. Phone/Fax

Practice location:
  • Phone: 505-356-0022
  • Fax: 505-404-8720
Mailing address:
  • Phone: 505-356-0022
  • Fax: 505-404-8720

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: MRS. BRENDA BARELA
Title or Position: CEO
Credential:
Phone: 505-389-9326