Provider Demographics
NPI:1396014544
Name:BRIDGES TO RECOVERY III
Entity Type:Organization
Organization Name:BRIDGES TO RECOVERY III
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 1:1460 SAN REMO DR.
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-459-0613
Mailing Address - Fax:310-573-7092
Practice Address - Street 1:777 SARBONNE RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-3320
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 RECOVERY II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198601411320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness