Provider Demographics
NPI:1538626296
Name:A BRIDGE TO INDEPENDENCE
Entity type:Organization
Organization Name:A BRIDGE TO INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-874-3483
Mailing Address - Street 1:PO BOX 4307
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1118
Mailing Address - Country:US
Mailing Address - Phone:814-392-2490
Mailing Address - Fax:
Practice Address - Street 1:2028 FILMORE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2939
Practice Address - Country:US
Practice Address - Phone:814-874-3483
Practice Address - Fax:814-651-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102704090Medicaid