Provider Demographics
NPI:1073090098
Name:BRIDGE SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:BRIDGE SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASSUMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-747-7984
Mailing Address - Street 1:PO BOX 10272
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-0272
Mailing Address - Country:US
Mailing Address - Phone:207-747-7984
Mailing Address - Fax:
Practice Address - Street 1:264 COUNTY RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1913
Practice Address - Country:US
Practice Address - Phone:207-747-7984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities