Provider Demographics
NPI:1841760808
Name:BRIDGING LEGACIES II
Entity Type:Organization
Organization Name:BRIDGING LEGACIES II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HEDGEPETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-467-6645
Mailing Address - Street 1:125 KILLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-6397
Mailing Address - Country:US
Mailing Address - Phone:910-467-6645
Mailing Address - Fax:
Practice Address - Street 1:1510 ROSE TERRACE CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-9041
Practice Address - Country:US
Practice Address - Phone:910-467-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGING LEGACIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty