Organization
BRIDGING THE GAP SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESHAWN SMITH GROUP HOME PROVIDER (OWNER)
(786) 368-8183
Entity
Organization
Contact information
Practice address
2551 NW 47TH ST, MIAMI, FL 33142-4655
(786) 368-8183
Mailing address
550 NW 214TH ST APT 104, MIAMI, FL 33169-2177
(786) 368-8183
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
11-1248-GH
FL
Other
Enumeration date
12/08/2017
Last updated
06/20/2018
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