MEDICARE: BRIDGE BUILDERS AOAF CENTRAL

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	251B00000X	Case Management Agency	25B00000X	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1649692112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE BUILDERS AOAF CENTRAL

Provider Business Mailing Address
First Line	:	6873 W. COLONIAL DR..
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818
Country	:	US
Telephone Number	:	407-296-0002
Fax Number	:	407-295-2008

Provider Business Practice Location Address
First Line	:	6873 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6827
Country	:	US
Telephone Number	:	407-296-0002
Fax Number	:	407-295-2008

Authorized Official
Title or Position	:	OWNER
Name	:	DELORIS WILLIAMS BATTLE
Credential	:
Telephone Number	:	407-296-0002

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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