MEDICARE: BRIDGING THE GAP LEARNING CENTER, L.L.C.

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	302F00000X	Exclusive Provider Organization		VA

General Provider Information

NPI Number	:	1669804183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP LEARNING CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	4410 CLAIBORNE SQ E
Second Line	:	334
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	757-871-4439
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 CLAIBORNE SQ E
Second Line	:	334
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	757-871-4439
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/PRESIDENT
Name	:	MRS. LASHONDRA DENISE RICE
Credential	:
Telephone Number	:	757-268-6586

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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