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General NPI Number Information
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NPI Number | 1417149311
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Entity Type | Organization
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Legal Business Name | BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 1219 CAMBRIDGE AVE
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City | GASTONIA
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State | NC
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Zip | 28054-1528
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Country | US
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Telephone | 704-864-4623
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Fax | 704-864-3331
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Provider Business Mailing Address
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Address Line | PO BOX 3707
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City | GASTONIA
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State | NC
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Zip | 28054-0020
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Country | US
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Telephone | 704-864-4623
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Fax | 704-864-3331
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. VERNON TYRONNE GRIER
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Credential | B.A.
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Telephone | 704-864-4623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHS-036-219
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License Number State | NC
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