Provider Demographics
NPI:1730630955
Name:BRIDGING GAPS WITH NEW BEGINNING
Entity type:Organization
Organization Name:BRIDGING GAPS WITH NEW BEGINNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:MADC ADT
Authorized Official - Phone:240-237-6071
Mailing Address - Street 1:4128 HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4337
Mailing Address - Country:US
Mailing Address - Phone:443-473-6804
Mailing Address - Fax:
Practice Address - Street 1:4128 HAYWARD AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-9998
Practice Address - Country:US
Practice Address - Phone:443-473-6804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE AREA COMMUNITY HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD906242251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health