Provider Demographics
NPI:1376307686
Name:BRIDGES OF WILMINGTON
Entity Type:Organization
Organization Name:BRIDGES OF WILMINGTON
Other - Org Name:BRIDGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODSON-SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-1733
Mailing Address - Street 1:202 S 5TH AVE UNIT C-4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5494
Mailing Address - Country:US
Mailing Address - Phone:910-685-1233
Mailing Address - Fax:910-762-1766
Practice Address - Street 1:202 S 5TH AVE UNIT C-4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5494
Practice Address - Country:US
Practice Address - Phone:910-762-1733
Practice Address - Fax:910-762-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083876049Medicaid