Provider Demographics
NPI:1821233156
Name:THE BRIDGE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:THE BRIDGE WELLNESS CENTER, LLC
Other - Org Name:D&K SUNSET INVESTMENTS LLC MBR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MONTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-772-0513
Mailing Address - Street 1:106404 S 293 PR SW
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-9415
Mailing Address - Country:US
Mailing Address - Phone:541-571-0214
Mailing Address - Fax:509-786-1020
Practice Address - Street 1:991 W 230 S
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:UT
Practice Address - Zip Code:84763
Practice Address - Country:US
Practice Address - Phone:435-772-0513
Practice Address - Fax:435-772-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14803323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility