Provider Demographics
NPI:1811021488
Name:JOANN BRIDGES ACADEMY
Entity Type:Organization
Organization Name:JOANN BRIDGES ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TUWOLLAR
Authorized Official - Middle Name:MESHET
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-948-4220
Mailing Address - Street 1:950 SW GREENVILLE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3108
Mailing Address - Country:US
Mailing Address - Phone:850-948-4220
Mailing Address - Fax:850-948-4227
Practice Address - Street 1:950 SW GREENVILLE HILLS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3108
Practice Address - Country:US
Practice Address - Phone:850-948-4220
Practice Address - Fax:850-948-4227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JFS DEVELOPMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075419600Medicaid