| Bridging The Gap Services, Llc | |
|
3649 Leonardtown Rd Waldorf MD 20601-3626 | |
| (240) 318-5790 | |
| (240) 436-1349 |
| Full Name | Bridging The Gap Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3649 Leonardtown Rd, Waldorf, Maryland |
| Authorized Official Name and Position | Karen Kemp (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2403185790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridging The Gap Services, Llc 5506 Windsor Dr Temple Hills MD 20748-4052 Ph: (240) 318-5790 | Bridging The Gap Services, Llc 3649 Leonardtown Rd Waldorf MD 20601-3626 Ph: (240) 318-5790 |
| NPI Number | 1225480494 |
|---|---|
| Provider Enumeration Date | 07/12/2016 |
| Last Update Date | 09/17/2022 |
| Certification Date | 09/17/2022 |
| Medicare PECOS PAC ID | 3577819838 |
|---|---|
| Medicare Enrollment ID | O20180629000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225480494 | NPI | - | NPPES |
| 423396400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 906023 (Maryland) | Primary |
| Provider Name | Yolanda Anita Lewis-ragland |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356304836 PECOS PAC ID: 1052489978 Enrollment ID: I20081006000372 |
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