Provider Demographics
NPI:1851350300
Name:BRIDGES HEALTHCARE INC.
Entity Type:Organization
Organization Name:BRIDGES HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-878-6365
Mailing Address - Street 1:949 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3142
Mailing Address - Country:US
Mailing Address - Phone:203-878-6365
Mailing Address - Fax:203-301-2397
Practice Address - Street 1:949 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3142
Practice Address - Country:US
Practice Address - Phone:203-878-6365
Practice Address - Fax:203-301-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0316261QM0850X
CT0313261QM0850X
CT0314261QM0850X
CTC0034261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT77ABH0005CT01OtherANTHEM BCBS
CT165319OtherVALUE OPTIONS
CTANC 1406OtherOXFORD HEALTH PLAN
CT004039244Medicaid
CT118591000OtherMAGELLAN PROVIDER NUMBER
CT118591000OtherMAGELLAN PROVIDER NUMBER
CTC01625Medicare ID - Type UnspecifiedPROVIDER NUMBER