Provider Demographics
NPI:1821485244
Name:THE BRIDGE PROGRAM
Entity Type:Organization
Organization Name:THE BRIDGE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MSD
Authorized Official - Phone:757-818-9336
Mailing Address - Street 1:850 TIDEWATER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-3300
Mailing Address - Country:US
Mailing Address - Phone:757-818-9336
Mailing Address - Fax:757-533-9634
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-818-9336
Practice Address - Fax:757-533-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPA302253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency