Provider Demographics
NPI:1073251377
Name:BRIDGE TO BALANCE
Entity Type:Organization
Organization Name:BRIDGE TO BALANCE
Other - Org Name:DREAMING WRIGHT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-705-1011
Mailing Address - Street 1:1222 E BASELINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1433
Mailing Address - Country:US
Mailing Address - Phone:608-705-1011
Mailing Address - Fax:
Practice Address - Street 1:1222 E BASELINE RD STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1433
Practice Address - Country:US
Practice Address - Phone:602-705-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No174200000XOther Service ProvidersMeals
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children