Organization
BRIDGING THE GAP RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHELIA BENTON (OWNER)
(919) 641-8378
Entity
Organization
Contact information
Practice address
2945 S MIAMI BLVD, SUITE 114, DURHAM, NC 27703-8024
(919) 641-8378
(919) 964-3364
Mailing address
2945 S MIAMI BLVD, SUITE 114, DURHAM, NC 27703-8024
(919) 641-8378
(919) 964-3364
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-032-520
NC
310400000X
Assisted Living Facility
MHL-032-419
NC
310400000X
Assisted Living Facility
MHL-032-451
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418478
—
NC
Enumeration date
10/15/2007
Last updated
04/14/2016
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