Provider Demographics
NPI:1700593027
Name:A BRIDGE FOR MY BROTHER
Entity Type:Organization
Organization Name:A BRIDGE FOR MY BROTHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-810-2636
Mailing Address - Street 1:705 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3845
Mailing Address - Country:US
Mailing Address - Phone:469-810-2636
Mailing Address - Fax:
Practice Address - Street 1:705 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3845
Practice Address - Country:US
Practice Address - Phone:469-810-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle