Provider Demographics
NPI:1245678184
Name:BRIDGE OF HOPE CENTRAL FLORIDA
Entity type:Organization
Organization Name:BRIDGE OF HOPE CENTRAL FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AS
Authorized Official - Phone:407-575-4636
Mailing Address - Street 1:PO BOX 452878
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-2878
Mailing Address - Country:US
Mailing Address - Phone:407-575-4636
Mailing Address - Fax:321-250-7425
Practice Address - Street 1:1331 KEVSTIN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5844
Practice Address - Country:US
Practice Address - Phone:407-575-4536
Practice Address - Fax:321-250-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21145225100000X
FLOT 1181225X00000X
FLSA10475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000867500Medicaid
FL000867502Medicaid
FL000867501Medicaid