Provider Demographics
NPI:1639485824
Name:BRIDGE TO SUCCESS
Entity Type:Organization
Organization Name:BRIDGE TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:207-890-0715
Mailing Address - Street 1:20 PARIS ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5654
Mailing Address - Country:US
Mailing Address - Phone:207-744-9440
Mailing Address - Fax:207-744-9441
Practice Address - Street 1:20 PARIS ST STE 4
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5654
Practice Address - Country:US
Practice Address - Phone:207-744-9440
Practice Address - Fax:207-744-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435915000OtherMAINECARE PROVIDER ID NUMBER