Provider Demographics
NPI:1275955874
Name:BRIDGING THE GAP RECOVERY, LLC
Entity Type:Organization
Organization Name:BRIDGING THE GAP RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURPHREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-249-4300
Mailing Address - Street 1:220 S ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2151
Mailing Address - Country:US
Mailing Address - Phone:850-249-4300
Mailing Address - Fax:850-640-1174
Practice Address - Street 1:220 S ARNOLD RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2151
Practice Address - Country:US
Practice Address - Phone:850-249-4300
Practice Address - Fax:850-640-1174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACHCOMBER RETREAT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-16
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1403AD666203324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility