Provider Demographics
NPI:1568886430
Name:BECKY'S BRIDGES, LLC
Entity Type:Organization
Organization Name:BECKY'S BRIDGES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ TARGETED CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-640-9323
Mailing Address - Street 1:9090 N JENNIE BARKER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-9357
Mailing Address - Country:US
Mailing Address - Phone:620-640-9323
Mailing Address - Fax:620-272-0524
Practice Address - Street 1:9090 N JENNIE BARKER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-9357
Practice Address - Country:US
Practice Address - Phone:620-640-9323
Practice Address - Fax:620-272-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========Medicaid