Organization
BRIDGE TO GRATITUDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARON CHRISTOPHER RANDOLPH JR. (DIRECTOR)
(619) 600-9595
Entity
Organization
Contact information
Practice address
6071 GOLD SPIRIT ST, EASTVALE, CA 92880-0989
(619) 600-9595
Mailing address
1801 TOWN AND COUNTRY DR UNIT 5944, NORCO, CA 92860-8197
(619) 600-9595
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251B00000X
Case Management Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
10/05/2019
Last updated
03/25/2025
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