Provider Demographics
NPI:1013375054
Name:BRIDGE FOR KIDS
Entity Type:Organization
Organization Name:BRIDGE FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-365-5692
Mailing Address - Street 1:6080 CENTER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1540
Mailing Address - Country:US
Mailing Address - Phone:310-365-5692
Mailing Address - Fax:
Practice Address - Street 1:6080 CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1540
Practice Address - Country:US
Practice Address - Phone:310-365-5692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-14-17370251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health