Provider Demographics
NPI:1912063835
Name:BRIDGEBUILDERS
Entity Type:Organization
Organization Name:BRIDGEBUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-864-4623
Mailing Address - Street 1:PO BOX 3707
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0020
Mailing Address - Country:US
Mailing Address - Phone:704-864-4623
Mailing Address - Fax:704-864-3331
Practice Address - Street 1:1752 COUNTRY CLUB RD
Practice Address - Street 2:UNIT B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4800
Practice Address - Country:US
Practice Address - Phone:704-864-4623
Practice Address - Fax:704-864-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006011Medicaid
NC8300697HMedicaid
NC8300697GMedicaid
NC8300697BMedicaid
NC8300697Medicaid