Provider Demographics
NPI:1497234207
Name:BRIDGE COMMUNITY OUTREACH INC
Entity Type:Organization
Organization Name:BRIDGE COMMUNITY OUTREACH INC
Other - Org Name:MS.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-953-5120
Mailing Address - Street 1:5979 NW 151ST ST STE 102I
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2434
Mailing Address - Country:US
Mailing Address - Phone:786-953-5120
Mailing Address - Fax:786-636-6965
Practice Address - Street 1:5979 NW 151ST ST STE 102I
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2434
Practice Address - Country:US
Practice Address - Phone:786-953-5120
Practice Address - Fax:786-636-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty