Provider Demographics
NPI:1093152076
Name:BRIDGES TO RECOVERY IIII
Entity Type:Organization
Organization Name:BRIDGES TO RECOVERY IIII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERIK
Authorized Official - Middle Name:VILHELM
Authorized Official - Last Name:SCHULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-459-0613
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1493
Mailing Address - Country:US
Mailing Address - Phone:310-459-0613
Mailing Address - Fax:310-573-7092
Practice Address - Street 1:10201 CHARING CROSS RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-1814
Practice Address - Country:US
Practice Address - Phone:310-459-0613
Practice Address - Fax:310-573-7092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES TO RECOVER II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMHBS130185320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness