Provider Demographics
NPI:1063160026
Name:MENDING BRIDGES CASE MANAGEMENT
Entity type:Organization
Organization Name:MENDING BRIDGES CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-MORANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-833-8124
Mailing Address - Street 1:404 JEROME DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6017
Mailing Address - Country:US
Mailing Address - Phone:843-833-8124
Mailing Address - Fax:
Practice Address - Street 1:552 OATLAND RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-5983
Practice Address - Country:US
Practice Address - Phone:843-833-8124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty