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General NPI Number Information
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NPI Number | 1740340421
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Entity Type | Organization
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Legal Business Name | BRIDGING TO SUCCESS
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 223 WEST 12TH
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City | SALISBURY
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State | NC
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Zip | 28144-3507
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Country | US
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Telephone | 704-637-7562
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Fax | 704-636-0075
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Provider Business Mailing Address
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Address Line | 345 BONANZA DR
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City | SALISBURY
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State | NC
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Zip | 28144-9422
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Country | US
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Telephone | 704-637-7562
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PHILOMENA CHIKA DURU
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Credential | BSN, MSN
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Telephone | 701-281-9281
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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 |
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License Number State |
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Taxonomy #2
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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 | MHL-080-139
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License Number State | NC
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