Provider Demographics
NPI:1083876049
Name:BRIDGES OF WILMINGTON, LLC
Entity Type:Organization
Organization Name:BRIDGES OF WILMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODSON-SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-1733
Mailing Address - Street 1:PO BOX 12717
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-0137
Mailing Address - Country:US
Mailing Address - Phone:910-762-1733
Mailing Address - Fax:910-762-1766
Practice Address - Street 1:3951B MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1403
Practice Address - Country:US
Practice Address - Phone:910-762-1733
Practice Address - Fax:910-762-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management