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General NPI Number Information
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NPI Number | 1811021488
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Entity Type | Organization
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Legal Business Name | JOANN BRIDGES ACADEMY
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 950 SW GREENVILLE HILLS RD
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City | GREENVILLE
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State | FL
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Zip | 32331-3108
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Country | US
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Telephone | 850-948-4220
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Fax | 850-948-4227
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Provider Business Mailing Address
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Address Line | 950 SW GREENVILLE HILLS RD
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City | GREENVILLE
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State | FL
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Zip | 32331-3108
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Country | US
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Telephone | 850-948-4220
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Fax | 850-948-4227
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | MS. TUWOLLAR MESHET MOBLEY
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Credential |
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Telephone | 850-948-4220
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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 |
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License Number State | FL
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