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NPI Code Detail

MEDICARE: BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.

MEDICARE: BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment FacilityMHS-036-219NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417149311
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
Provider Business Mailing Address
First Line : PO BOX 3707
Second Line :
City : GASTONIA
State : NC
Zip : 28054-0020
Country : US
Telephone Number : 704-864-4623
Fax Number : 704-864-3331
Provider Business Practice Location Address
First Line : 1219 CAMBRIDGE AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28054-1528
Country : US
Telephone Number : 704-864-4623
Fax Number : 704-864-3331
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. VERNON TYRONNE GRIER
Credential : B.A.
Telephone Number : 704-864-4623
Provider Enumeration Date : 08/14/2007
Last Update Date : 01/24/2008

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Directions to “BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC. ” Practice Location

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