| Bridges Community Support Services, Inc | |
|
5222 Andrus Ave Ste C Orlando FL 32810-5456 | |
| (407) 745-5022 | |
| (407) 601-4302 |
| Full Name | Bridges Community Support Services, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5222 Andrus Ave Ste C, Orlando, Florida |
| Authorized Official Name and Position | Omusi Ranger (CEO) |
| Authorized Official Contact | 4077455022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridges Community Support Services, Inc 5222 Andrus Ave Ste C Orlando FL 32810-5456 Ph: (407) 745-5022 | Bridges Community Support Services, Inc 5222 Andrus Ave Ste C Orlando FL 32810-5456 Ph: (407) 745-5022 |
| NPI Number | 1043612344 |
|---|---|
| Provider Enumeration Date | 09/18/2014 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 9638419476 |
|---|---|
| Medicare Enrollment ID | O20240529000767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043612344 | NPI | - | NPPES |
| 013945100 | Medicaid | FL | |
| 010616500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0106165 (Florida) | Primary |
| Provider Name | Mirline Lamothe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205549573 PECOS PAC ID: 6103365382 Enrollment ID: I20240903000061 |
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