Provider Demographics
NPI:1518087477
Name:BRIDGES ALCOHOL AND DRUG REHABILITATION CENTERS
Entity Type:Organization
Organization Name:BRIDGES ALCOHOL AND DRUG REHABILITATION CENTERS
Other - Org Name:NEW BRIDGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSTIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-455-8283
Mailing Address - Street 1:3500 VIRGINIA BEACH BLVD
Mailing Address - Street 2:STE 410
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4445
Mailing Address - Country:US
Mailing Address - Phone:757-455-8283
Mailing Address - Fax:757-486-1094
Practice Address - Street 1:3500 VIRGINIA BEACH BLVD
Practice Address - Street 2:STE 410
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4445
Practice Address - Country:US
Practice Address - Phone:757-455-8283
Practice Address - Fax:757-486-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8911738Medicaid
VA=========Medicare UPIN