MEDICARE: JOANN BRIDGES ACADEMY

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	320800000X	Mental Illness Community Based Residential Treatment Facility		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	:	1811021488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANN BRIDGES ACADEMY

Provider Business Mailing Address
First Line	:	950 SW GREENVILLE HILLS RD
Second Line	:
City	:	GREENVILLE
State	:	FL
Zip	:	32331-3108
Country	:	US
Telephone Number	:	850-948-4220
Fax Number	:	850-948-4227

Provider Business Practice Location Address
First Line	:	950 SW GREENVILLE HILLS RD
Second Line	:
City	:	GREENVILLE
State	:	FL
Zip	:	32331-3108
Country	:	US
Telephone Number	:	850-948-4220
Fax Number	:	850-948-4227

Authorized Official
Title or Position	:	FACILITY ADMINISTRATOR
Name	:	MS. TUWOLLAR MESHET MOBLEY
Credential	:
Telephone Number	:	850-948-4220

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	06/20/2008

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