MEDICARE: FAMILY BRIDGE SUPPORT SERVICES LLC

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
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1588510978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY BRIDGE SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	5705 WALLIS LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7627
Country	:	US
Telephone Number	:	407-552-7335
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 ORLEANS DR
Second Line	:
City	:	EAGLE LAKE
State	:	FL
Zip	:	33839-5216
Country	:	US
Telephone Number	:	407-552-7335
Fax Number	:

Authorized Official
Title or Position	:	OWNER /CEO
Name	:	MRS. ERICA SERENA FREEMAN
Credential	:
Telephone Number	:	407-552-7335

Provider Enumeration Date	:	03/07/2026
Last Update Date	:	03/07/2026

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