Provider Demographics
NPI:1467692137
Name:COMMUNITY BRIDGES WEST, INC.
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-9137
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0715
Mailing Address - Country:US
Mailing Address - Phone:318-255-9137
Mailing Address - Fax:318-255-8233
Practice Address - Street 1:1201 ATKINS RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8717
Practice Address - Country:US
Practice Address - Phone:318-255-9137
Practice Address - Fax:318-255-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care