Provider Demographics
NPI:1063552347
Name:BRIDGING THE GAP PREFERRED INC
Entity type:Organization
Organization Name:BRIDGING THE GAP PREFERRED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-793-2209
Mailing Address - Street 1:504 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-1419
Mailing Address - Country:US
Mailing Address - Phone:252-793-2209
Mailing Address - Fax:252-793-2035
Practice Address - Street 1:504 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1419
Practice Address - Country:US
Practice Address - Phone:252-793-2209
Practice Address - Fax:252-793-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418068Medicaid
NC8301683Medicaid