Provider Demographics
NPI:1043612344
Name:BRIDGES COMMUNITY SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:BRIDGES COMMUNITY SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMUSI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-745-5022
Mailing Address - Street 1:5222 ANDRUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:407-745-5022
Mailing Address - Fax:407-601-4302
Practice Address - Street 1:5222 ANDRUS AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:407-745-5022
Practice Address - Fax:407-601-4302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES COMMUNITY SUPPORT SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0106165251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013945100Medicaid
FL010616500Medicaid