Provider Demographics
NPI:1972797272
Name:BRIDGES GROUP HOME, INC.
Entity Type:Organization
Organization Name:BRIDGES GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/QP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-785-2367
Mailing Address - Street 1:1274 NC HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-0000
Mailing Address - Country:US
Mailing Address - Phone:910-785-2667
Mailing Address - Fax:
Practice Address - Street 1:1274 NC HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-0215
Practice Address - Country:US
Practice Address - Phone:910-785-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-169322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603908Medicaid