Provider Demographics
NPI:1639509870
Name:BRIDGES PROFESSIONAL TREATMENT SERVICES
Entity Type:Organization
Organization Name:BRIDGES PROFESSIONAL TREATMENT SERVICES
Other - Org Name:PROMISE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-203-7848
Mailing Address - Street 1:2727 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6403
Mailing Address - Country:US
Mailing Address - Phone:916-452-3073
Mailing Address - Fax:
Practice Address - Street 1:2727 P ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6403
Practice Address - Country:US
Practice Address - Phone:916-452-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340041BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility