Provider Demographics
NPI:1407153984
Name:NORTHBRIDGE, LLC
Entity Type:Organization
Organization Name:NORTHBRIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-362-5235
Mailing Address - Street 1:3155 RIVER RD S STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9819
Mailing Address - Country:US
Mailing Address - Phone:503-362-5235
Mailing Address - Fax:
Practice Address - Street 1:310 K ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2064
Practice Address - Country:US
Practice Address - Phone:907-264-6628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK950483251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC# PENDINGMedicaid