Organization
BRIDGE THE GAP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QUINCY SANDERS (EXECUTIVE DIRECTOR)
(702) 505-3635
Entity
Organization
Contact information
Practice address
9811 W CHARLESTON BLVD STE 2538, LAS VEGAS, NV 89117-7528
(702) 505-3635
Mailing address
9811 W CHARLESTON BLVD, STE. 2-538, LAS VEGAS, NV 89117-7528
(702) 202-0789
(702) 202-0792
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710295860
—
NV
05
—
9005056211
—
NV
Enumeration date
09/22/2010
Last updated
07/27/2015
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