Provider Demographics
NPI:1386201150
Name:A BRIDGE TO ACHIEVEMENT
Entity Type:Organization
Organization Name:A BRIDGE TO ACHIEVEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXCECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-560-7878
Mailing Address - Street 1:1959 N PEACE HAVEN RD # 104
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4850
Mailing Address - Country:US
Mailing Address - Phone:336-560-7878
Mailing Address - Fax:833-772-8118
Practice Address - Street 1:1959 N PEACE HAVEN RD # 104
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4850
Practice Address - Country:US
Practice Address - Phone:336-560-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center