Provider Demographics
NPI:1801923198
Name:THE BRIDGE AT FAIR PARK, LLC
Entity type:Organization
Organization Name:THE BRIDGE AT FAIR PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-565-7823
Mailing Address - Street 1:2535 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-2306
Mailing Address - Country:US
Mailing Address - Phone:214-565-7823
Mailing Address - Fax:214-565-0246
Practice Address - Street 1:2535 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2306
Practice Address - Country:US
Practice Address - Phone:214-565-7823
Practice Address - Fax:214-565-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102501OtherADULT DAY CARE FACILITY #
TX119241OtherADULT DAY CARE LICENSE #