Provider Demographics
NPI:1790814697
Name:BRIDGING THE GAP FAMILY CARE HOME, INC.
Entity Type:Organization
Organization Name:BRIDGING THE GAP FAMILY CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-389-8350
Mailing Address - Street 1:56 W VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-5603
Mailing Address - Country:US
Mailing Address - Phone:828-389-8350
Mailing Address - Fax:828-389-9064
Practice Address - Street 1:56 W VINEYARD LN
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-5603
Practice Address - Country:US
Practice Address - Phone:828-389-8350
Practice Address - Fax:828-389-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL022002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility