Provider Demographics
NPI:1104090372
Name:BRIDGES TREATMENT & RECOVERY LLC
Entity type:Organization
Organization Name:BRIDGES TREATMENT & RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRASHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-714-8180
Mailing Address - Street 1:1221 FRASER ST STE E1
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5844
Mailing Address - Country:US
Mailing Address - Phone:360-714-8180
Mailing Address - Fax:360-676-5259
Practice Address - Street 1:1221 FRASER ST STE E1
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5844
Practice Address - Country:US
Practice Address - Phone:360-714-8180
Practice Address - Fax:360-676-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602791805251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health