Provider Demographics
NPI:1083894554
Name:BRIDGES AND BEYOND
Entity Type:Organization
Organization Name:BRIDGES AND BEYOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-554-3001
Mailing Address - Street 1:104 S WHITE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2773
Mailing Address - Country:US
Mailing Address - Phone:919-554-0013
Mailing Address - Fax:
Practice Address - Street 1:104 S WHITE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2773
Practice Address - Country:US
Practice Address - Phone:919-554-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency