Provider Demographics
NPI:1881339521
Name:BRIDGE TO SUCCESS
Entity type:Organization
Organization Name:BRIDGE TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-389-9326
Mailing Address - Street 1:PO BOX 25447
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-0447
Mailing Address - Country:US
Mailing Address - Phone:505-356-0022
Mailing Address - Fax:505-404-8720
Practice Address - Street 1:5308 COAL AVE SE UNIT A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2907
Practice Address - Country:US
Practice Address - Phone:505-356-0022
Practice Address - Fax:505-404-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care