Provider Demographics
NPI:1679010656
Name:BRIDGES TO GREATER GRACE FOUNDATION
Entity Type:Organization
Organization Name:BRIDGES TO GREATER GRACE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYRON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS
Authorized Official - Phone:718-924-7530
Mailing Address - Street 1:820 N 45TH ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1377
Mailing Address - Country:US
Mailing Address - Phone:718-924-7530
Mailing Address - Fax:
Practice Address - Street 1:820 N 45TH ST UNIT 202
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1377
Practice Address - Country:US
Practice Address - Phone:718-924-7530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities