| Name: | Building A Bridge |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 16 Apr 2013 (12 years ago) |
| Entity Number: | 000-280-168 |
| Register Number: | 000280168 |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 101 MEDICAL DRIVEDOTHAN, AL 36303 |
| Registered Office Street Address ZIP Code: | 36303 |
Activities
PROVIDE MENTAL HEALTH SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508278136 | 2014-06-02 | 2014-06-02 | 101 MEDICAL DR, DOTHAN, AL, 363036903, US | 101 MEDICAL DR, DOTHAN, AL, 363036903, US | |||||||||||||||||||||||||
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| Phone | +1 334-702-7222 |
| Fax | 3347021944 |
Authorized person
| Name | MRS. DENISE CLEVELAND |
| Role | PRESIDENT |
| Phone | 3347027222 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | 3655C |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1043519739 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CLEVELAND, DENISE B | Agent | 101 MEDICAL DRIVEDOTHAN, AL 36303 |
| Name | Role | Address |
|---|---|---|
| CLEVELAND, DENISE B | Director | 101 MEDICAL DRIVEDOTHAN, AL 36303 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
