Provider Demographics
NPI:1659877355
Name:BRIDGES COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:BRIDGES COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED MENTAL HEALTH CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RANEA
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:662-567-2319
Mailing Address - Street 1:5222 ANDRUS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5400
Mailing Address - Country:US
Mailing Address - Phone:407-745-5022
Mailing Address - Fax:407-601-4302
Practice Address - Street 1:5222 ANDRUS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5400
Practice Address - Country:US
Practice Address - Phone:407-745-5022
Practice Address - Fax:407-601-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL464686250Medicaid