Provider Demographics
NPI:1275277022
Name:NEW BRIDGE GROUPHOME
Entity Type:Organization
Organization Name:NEW BRIDGE GROUPHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YETUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-556-2176
Mailing Address - Street 1:232 PENINSULA WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7395
Mailing Address - Country:US
Mailing Address - Phone:803-556-2176
Mailing Address - Fax:803-814-2493
Practice Address - Street 1:232 PENINSULA WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7395
Practice Address - Country:US
Practice Address - Phone:803-556-2176
Practice Address - Fax:803-814-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility