Provider Demographics
NPI:1609140342
Name:THE PASSAGE, INC.
Entity Type:Organization
Organization Name:THE PASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:386-882-4398
Mailing Address - Street 1:9238 HIDDEN WATER CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3028
Mailing Address - Country:US
Mailing Address - Phone:813-527-3699
Mailing Address - Fax:
Practice Address - Street 1:9238 HIDDEN WATER CIR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3028
Practice Address - Country:US
Practice Address - Phone:813-527-3699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health