MEDICARE: BRIDGING BETWEEN GAPS

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1780934174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING BETWEEN GAPS

Provider Business Mailing Address
First Line	:	620 GIBSON RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-4405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 GIBSON RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-4405
Country	:	US
Telephone Number	:	410-615-4025
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YOLANDA R BARNES
Credential	:
Telephone Number	:	410-615-4025

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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Directions to “BRIDGING BETWEEN GAPS ” Practice Location

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