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General NPI Number Information
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NPI Number | 1861907115
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Entity Type | Organization
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Legal Business Name | BRIDGING THE GAP SERVICES LLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2551 NW 47TH ST
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City | MIAMI
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State | FL
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Zip | 33142-4655
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Country | US
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Telephone | 786-368-8183
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Fax |
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Provider Business Mailing Address
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Address Line | 550 NW 214TH ST APT 104
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City | MIAMI
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State | FL
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Zip | 33169-2177
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Country | US
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Telephone | 786-368-8183
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DESHAWN SMITH
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Credential | GROUP HOME PROVIDER
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Telephone | 786-368-8183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 11-1248-GH
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License Number State | FL
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