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General NPI Number Information
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NPI Number | 1023141918
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Entity Type | Organization
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Legal Business Name | THE BRIDGE, INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1559 JOHNSON RD NW
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City | ATLANTA
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State | GA
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Zip | 30318-4017
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Country | US
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Telephone | 404-792-0070
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Fax | 404-794-0444
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Provider Business Mailing Address
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Address Line | 1559 JOHNSON RD NW
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City | ATLANTA
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State | GA
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Zip | 30318-4017
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Country | US
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Telephone | 404-792-0070
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Fax | 404-794-0444
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Authorized Official
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Title or Position | CFO
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Name | MR. THOMAS AUSTIN WEBB
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Credential |
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Telephone | 404-446-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CCI-10054
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CCI-10054
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License Number State | GA
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