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General NPI Number Information
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NPI Number | 1215443627
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Entity Type | Organization
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Legal Business Name | BRIDGE BEHAVIORAL SERVICES CORP
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 5979 NW 151ST ST STE 102I
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City | MIAMI LAKES
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State | FL
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Zip | 33014
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Country | US
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Telephone | 786-953-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 5979 NW 151ST ST STE 102I
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2434
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Country | US
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Telephone | 786-953-5120
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BIANCA M GONZALEZ
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Credential |
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Telephone | 786-953-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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