Provider Demographics
NPI:1215682174
Name:BRIDGING THE GAP ADC
Entity type:Organization
Organization Name:BRIDGING THE GAP ADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-560-6345
Mailing Address - Street 1:909 TALBOTTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8851
Mailing Address - Country:US
Mailing Address - Phone:706-780-1024
Mailing Address - Fax:706-505-1128
Practice Address - Street 1:909 TALBOTTON RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8851
Practice Address - Country:US
Practice Address - Phone:706-780-1024
Practice Address - Fax:706-505-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care