Healthcare Provider Details

I. General information

NPI: 1548182710
Provider Name (Legal Business Name): BRIDGE TO PURPOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 E BROAD ST STE A
COLUMBUS OH
43213-1200
US

IV. Provider business mailing address

4207 E BROAD ST STE A
COLUMBUS OH
43213-1200
US

V. Phone/Fax

Practice location:
  • Phone: 614-626-1266
  • Fax: 614-626-1266
Mailing address:
  • Phone: 614-626-1266
  • Fax: 614-626-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MONIQUA WALLACE
Title or Position: OWNER
Credential:
Phone: 614-626-1266