Healthcare Provider Details

I. General information

NPI: 1770405136
Provider Name (Legal Business Name): THE BRIDGE HOUSEHOLD
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

2109 BAINBRIDGE ST
RICHMOND VA
23225-3931
US

IV. Provider business mailing address

PO BOX 26481
RICHMOND VA
23261-6481
US

V. Phone/Fax

Practice location:
  • Phone: 804-750-3468
  • Fax:
Mailing address:
  • Phone: 804-750-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS D WILKINS
Title or Position: CEO
Credential:
Phone: 804-750-3468