Provider Demographics
NPI:1467344093
Name:GOLAN BRIDGE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:GOLAN BRIDGE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:GABADIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-820-9900
Mailing Address - Street 1:440 MONTICELLO AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2670
Mailing Address - Country:US
Mailing Address - Phone:757-346-2110
Mailing Address - Fax:757-687-9927
Practice Address - Street 1:440 MONTICELLO AVE STE 1800
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2670
Practice Address - Country:US
Practice Address - Phone:757-346-2110
Practice Address - Fax:757-687-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)