Provider Demographics
NPI:1548634900
Name:BUILDING BRIDGES GROUP HOME, LLC
Entity type:Organization
Organization Name:BUILDING BRIDGES GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-462-7688
Mailing Address - Street 1:716 FITZLEE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:VA
Mailing Address - Zip Code:24555-2530
Mailing Address - Country:US
Mailing Address - Phone:540-258-1098
Mailing Address - Fax:
Practice Address - Street 1:716 FITZLEE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:VA
Practice Address - Zip Code:24555-2530
Practice Address - Country:US
Practice Address - Phone:540-258-1098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2469-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities