Provider Demographics
NPI:1356163299
Name:MENDING BRIDGES LLC
Entity type:Organization
Organization Name:MENDING BRIDGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URETA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:657-216-4133
Mailing Address - Street 1:1082 FERNLEAF LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3677
Mailing Address - Country:US
Mailing Address - Phone:657-216-4133
Mailing Address - Fax:
Practice Address - Street 1:430 N STATE COLLEGE BLVD
Practice Address - Street 2:UNIT A AND C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2916
Practice Address - Country:US
Practice Address - Phone:657-216-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder