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General NPI Number Information
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NPI Number | 1770124265
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Entity Type | Organization
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Legal Business Name | BRIDGE TO GRATITUDE LLC
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Dates
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Enumeration Date | 10/05/2019
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 6071 GOLD SPIRIT ST
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City | EASTVALE
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State | CA
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Zip | 92880-0989
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Country | US
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Telephone | 619-600-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 TOWN AND COUNTRY DR UNIT 5944
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City | NORCO
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State | CA
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Zip | 92860-8197
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Country | US
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Telephone | 619-600-9595
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LARON CHRISTOPHER RANDOLPH JR.
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Credential |
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Telephone | 619-600-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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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 |
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License Number State |
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