Provider Demographics
NPI:1467836858
Name:BRIDGES PROFESSIONAL TREATMENT SERVICES
Entity Type:Organization
Organization Name:BRIDGES PROFESSIONAL TREATMENT SERVICES
Other - Org Name:BRIDGES MENS RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-583-2969
Mailing Address - Street 1:1731 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6104
Mailing Address - Country:US
Mailing Address - Phone:916-706-2007
Mailing Address - Fax:
Practice Address - Street 1:1731 P ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6104
Practice Address - Country:US
Practice Address - Phone:916-706-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility