Provider Demographics
NPI:1225480494
Name:BRIDGING THE GAP SERVICES, LLC
Entity Type:Organization
Organization Name:BRIDGING THE GAP SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CSC-AD
Authorized Official - Phone:240-318-5790
Mailing Address - Street 1:5506 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4052
Mailing Address - Country:US
Mailing Address - Phone:240-318-5790
Mailing Address - Fax:240-436-1949
Practice Address - Street 1:3649 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3626
Practice Address - Country:US
Practice Address - Phone:240-318-5790
Practice Address - Fax:240-436-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD906023251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423396400Medicaid