Provider Demographics
NPI:1437283561
Name:BRIDGES COMM TREATMENT SVS.INC.
Entity Type:Organization
Organization Name:BRIDGES COMM TREATMENT SVS.INC.
Other - Org Name:BRIDGES -CASITAS TRANQUILAS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-623-6651
Mailing Address - Street 1:279 E ARROW HWY
Mailing Address - Street 2:102
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3319
Mailing Address - Country:US
Mailing Address - Phone:909-623-6651
Mailing Address - Fax:909-623-0455
Practice Address - Street 1:11929 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732
Practice Address - Country:US
Practice Address - Phone:626-350-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES COMM TREATMENT SVS. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197800743320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness