Provider Demographics
NPI:1669737318
Name:BRIDGES FOR CHANGE, INC.
Entity type:Organization
Organization Name:BRIDGES FOR CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-787-8608
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:REYNOLDS
Mailing Address - State:GA
Mailing Address - Zip Code:31076-0221
Mailing Address - Country:US
Mailing Address - Phone:478-787-8608
Mailing Address - Fax:478-847-3356
Practice Address - Street 1:54 HARRIS ST.
Practice Address - Street 2:
Practice Address - City:REYNOLDS
Practice Address - State:GA
Practice Address - Zip Code:31076
Practice Address - Country:US
Practice Address - Phone:478-787-8608
Practice Address - Fax:478-847-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11834251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management