Provider Demographics
NPI:1114542800
Name:BRIDGING THE GAP HEALTHCARE INC
Entity type:Organization
Organization Name:BRIDGING THE GAP HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PHEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-815-8468
Mailing Address - Street 1:1020 10TH AVE W UNIT 91
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-3796
Mailing Address - Country:US
Mailing Address - Phone:209-815-8468
Mailing Address - Fax:888-472-6577
Practice Address - Street 1:1020 10TH AVE W UNIT 91
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-3796
Practice Address - Country:US
Practice Address - Phone:209-815-8468
Practice Address - Fax:888-472-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP20000035604OtherSECRETARY OF STATE ARTICLES OF FORMATION