Provider Demographics
NPI:1679909535
Name:BRIDGE BUILDING YOUTH AND FAMILY
Entity Type:Organization
Organization Name:BRIDGE BUILDING YOUTH AND FAMILY
Other - Org Name:VESSELS OF HONOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEADOWLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-207-2249
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:CLINCHCO
Mailing Address - State:VA
Mailing Address - Zip Code:24226-0366
Mailing Address - Country:US
Mailing Address - Phone:276-207-2249
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAYSI
Practice Address - State:VA
Practice Address - Zip Code:24256
Practice Address - Country:US
Practice Address - Phone:276-207-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty