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General NPI Number Information
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NPI Number | 1821485244
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Entity Type | Organization
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Legal Business Name | THE BRIDGE PROGRAM
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 850 TIDEWATER DR SUITE A
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City | NORFOLK
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State | VA
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Zip | 23504-3300
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Country | US
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Telephone | 757-818-9336
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Fax | 757-533-9634
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Provider Business Mailing Address
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Address Line | 850 TIDEWATER DR SUITE A
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City | NORFOLK
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State | VA
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Zip | 23504-3300
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Country | US
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Telephone | 757-818-9336
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Fax | 757-533-9634
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANDREA CLEAVES
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Credential | MSD
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Telephone | 757-818-9336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | CPA302
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License Number State | VA
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