Organization
BRIDGE OF LIFE SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA SHADE (ADMINISTRATOR)
(407) 813-3696
Entity
Organization
Contact information
Practice address
2201 MOTLEY WAY, TAVARES, FL 32778-4919
(407) 813-3696
(407) 813-3696
Mailing address
2201 MOTLEY WAY, TAVARES, FL 32778-4919
(407) 813-3696
(407) 813-3696
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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