Provider Demographics
| NPI: | 1326328998 |
|---|---|
| Name: | BRIDGE OF HOPE INC |
| Entity Type: | Organization |
| Organization Name: | BRIDGE OF HOPE INC |
| Other - Org Name: | BRIDGE OF HOPE INC. |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | VANESSA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ROMAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 407-575-4636 |
| Mailing Address - Street 1: | PO BOX 452878 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | KISSIMMEE |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 34745-2878 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 407-575-4636 |
| Mailing Address - Fax: | 321-250-7425 |
| Practice Address - Street 1: | 1331 KEVSTIN DR |
| Practice Address - Street 2: | |
| Practice Address - City: | KISSIMMEE |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34744-5844 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 407-575-4636 |
| Practice Address - Fax: | 321-250-7425 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-08-26 |
| Last Update Date: | 2011-08-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Single Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Group - Single Specialty | |
| No | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Group - Single Specialty |
