Provider Demographics
NPI:1407999691
Name:THE BRIDGE BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:THE BRIDGE BEHAVIORAL HEALTH, INC.
Other - Org Name:CORNHUSKER PLACE OF LINCOLN-LANCASTER COUNTY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-477-3951
Mailing Address - Street 1:721 K ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2949
Mailing Address - Country:US
Mailing Address - Phone:402-477-3951
Mailing Address - Fax:402-477-3922
Practice Address - Street 1:721 K ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2949
Practice Address - Country:US
Practice Address - Phone:402-477-3951
Practice Address - Fax:402-477-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X, 324500000X
NESATC017324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025684200Medicaid