1649280140 NPI number — BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES

Table of content: (NPI 1649280140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649280140 NPI number — BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUILDING BRIDGES DEVELOPMENTAL AND COMMUNITY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649280140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 980
Provider Second Line Business Mailing Address:
518 NE FRONT STREET
Provider Business Mailing Address City Name:
LONOKE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-676-2786
Provider Business Mailing Address Fax Number:
501-676-0697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 NE FRONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONOKE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-676-2786
Provider Business Practice Location Address Fax Number:
501-676-0697
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAGGETT
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
501-676-2786

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114235715 . This is a "MEDICAID EDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 130758767 . This is a "MEDICAID EDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 145866778 . This is a "MEDICAID EDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 116704742 . This is a "MEDICAID EDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 103281724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130760774 . This is a "MEDICAID EDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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