Provider Demographics
NPI:1649280140
Name:BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-676-2786
Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:518 NE FRONT STREET
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086
Mailing Address - Country:US
Mailing Address - Phone:501-676-2786
Mailing Address - Fax:501-676-0697
Practice Address - Street 1:518 NE FRONT STREET
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086
Practice Address - Country:US
Practice Address - Phone:501-676-2786
Practice Address - Fax:501-676-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251B00000X, 251C00000X, 343900000X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114235715OtherMEDICAID EDS
AR130758767OtherMEDICAID EDS
AR145866778OtherMEDICAID EDS
AR116704742OtherMEDICAID EDS
AR103281724Medicaid
AR130760774OtherMEDICAID EDS