=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881009850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BRIDGE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2014
-----------------------------------------------------
Last Update Date | 09/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2480 GOVERNMENT ST SUITE A
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36606-1632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-229-5767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2029 AIRPORT BLVD STE B NUMBER 180
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36606-1731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-229-5767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | REGINA WINBUSH ALEXANDER
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 251-229-6767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------