OrganizationActive
Bridge of Life Support Services
NPI 1861383184 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Tavares, FL
Provider details
- NPI number
- 1861383184
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Tamara Shade, Administrator(407) 813-3696
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
2201 Motley Way
Tavares, FL 32778-4919
Phone: (407) 813-3696
Fax: (407) 813-3696
Approximate (ZIP-level) locationGet directions
Mailing address
2201 Motley Way
Tavares, FL 32778-4919
Registry dates
- Enumerated
- 2025-07-14
- Last updated
- 2025-07-14
- Certified
- 2025-07-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.