Provider Demographics
NPI:1346697588
Name:BRIDGING MOUNTAINS LLC
Entity Type:Organization
Organization Name:BRIDGING MOUNTAINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-637-9001
Mailing Address - Street 1:2615 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-4330
Mailing Address - Country:US
Mailing Address - Phone:352-637-9001
Mailing Address - Fax:352-637-3003
Practice Address - Street 1:2615 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-4330
Practice Address - Country:US
Practice Address - Phone:352-637-9001
Practice Address - Fax:352-637-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003543000Medicaid