Provider Demographics
NPI:1497114599
Name:THE BRIDGE TO COMMUNITY SERVICES
Entity Type:Organization
Organization Name:THE BRIDGE TO COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAWA
Authorized Official - Middle Name:UMU
Authorized Official - Last Name:JALLOH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CASAC
Authorized Official - Phone:914-318-4686
Mailing Address - Street 1:76 HICKORY HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3012
Mailing Address - Country:US
Mailing Address - Phone:914-318-4686
Mailing Address - Fax:
Practice Address - Street 1:76 HICKORY HOLLOW PL
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3012
Practice Address - Country:US
Practice Address - Phone:914-318-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities