Provider Demographics
NPI:1235430265
Name:BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
Entity Type:Organization
Organization Name:BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:TYRONNE
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:704-451-7630
Mailing Address - Street 1:2025 EBENEZER RD STE G2
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1078
Mailing Address - Country:US
Mailing Address - Phone:803-619-6900
Mailing Address - Fax:803-619-6913
Practice Address - Street 1:2025 EBENEZER RD STE G2
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1078
Practice Address - Country:US
Practice Address - Phone:803-619-6900
Practice Address - Fax:803-619-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8703082Medicaid
NC3410080Medicaid