Provider Demographics
NPI:1609003540
Name:NORTHERNBRIDGES
Entity Type:Organization
Organization Name:NORTHERNBRIDGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-934-2266
Mailing Address - Street 1:15954 RIVERS EDGE DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-7887
Mailing Address - Country:US
Mailing Address - Phone:715-934-2266
Mailing Address - Fax:715-934-2268
Practice Address - Street 1:15954 RIVERS EDGE DR
Practice Address - Street 2:SUITE #300
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-7887
Practice Address - Country:US
Practice Address - Phone:715-934-2266
Practice Address - Fax:715-934-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69009009251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management