MEDICARE: BRIDGING THE GAP ADC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QD1600X	Developmental Disabilities Clinic/Center
3	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1063280501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP ADC LLC

Provider Business Mailing Address
First Line	:	6141 BROOKSTONE BLVD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2959
Country	:	US
Telephone Number	:	334-560-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 TALBOTTON RD STE C
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8851
Country	:	US
Telephone Number	:	706-780-1024
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS REGINA CRAWFORD
Credential	:	RN
Telephone Number	:	334-560-6345

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/15/2023

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