Provider Demographics
NPI:1750780227
Name:WESTBRIDGE INC
Entity type:Organization
Organization Name:WESTBRIDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSW
Authorized Official - Phone:603-634-4446
Mailing Address - Street 1:1361 ELM ST
Mailing Address - Street 2:STE 207
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1324
Mailing Address - Country:US
Mailing Address - Phone:603-634-4446
Mailing Address - Fax:
Practice Address - Street 1:275 MYSTIC AVE
Practice Address - Street 2:STE C
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6301
Practice Address - Country:US
Practice Address - Phone:781-396-2793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTBRIDGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03076320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness