Provider Demographics
NPI:1689042624
Name:BRIDGING THE GAP FAMILY SERVICES
Entity Type:Organization
Organization Name:BRIDGING THE GAP FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAHMELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-670-2651
Mailing Address - Street 1:919 E MAIN ST
Mailing Address - Street 2:STE 1040
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-4625
Mailing Address - Country:US
Mailing Address - Phone:703-881-7783
Mailing Address - Fax:
Practice Address - Street 1:919 E MAIN ST
Practice Address - Street 2:STE 1040
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-4625
Practice Address - Country:US
Practice Address - Phone:703-881-7783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600949770Medicaid