Provider Demographics
NPI:1629238811
Name:FAMILY BRIDGES
Entity Type:Organization
Organization Name:FAMILY BRIDGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:417-496-6444
Mailing Address - Street 1:718 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9797
Mailing Address - Country:US
Mailing Address - Phone:417-742-1000
Mailing Address - Fax:417-742-1001
Practice Address - Street 1:718 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9797
Practice Address - Country:US
Practice Address - Phone:417-742-1000
Practice Address - Fax:417-742-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child