Provider Demographics
NPI:1073161139
Name:BRIDGES HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BRIDGES HEALTHCARE, LLC
Other - Org Name:BRIDGES BEHAVIORAL HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:740-605-8839
Mailing Address - Street 1:P.O. BOX 212
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692
Mailing Address - Country:US
Mailing Address - Phone:740-605-8839
Mailing Address - Fax:
Practice Address - Street 1:1024 1/2 S. PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692
Practice Address - Country:US
Practice Address - Phone:740-384-7771
Practice Address - Fax:740-384-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251827Medicaid