Provider Demographics
NPI:1831505270
Name:BRIDGING THE GAP OUTPATIENT, LLC
Entity type:Organization
Organization Name:BRIDGING THE GAP OUTPATIENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,ICADC
Authorized Official - Phone:615-712-2222
Mailing Address - Street 1:115 PENN WARREN DR
Mailing Address - Street 2:SUITE 300-290
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5047
Mailing Address - Country:US
Mailing Address - Phone:615-712-2222
Mailing Address - Fax:615-457-8094
Practice Address - Street 1:221 SAN VINCENTE ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2126
Practice Address - Country:US
Practice Address - Phone:850-249-4300
Practice Address - Fax:615-457-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1403AD6415261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder