Provider Demographics
NPI:1952925984
Name:BRIDGE STREET RECOVERY LLC
Entity Type:Organization
Organization Name:BRIDGE STREET RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDM, MLADC
Authorized Official - Phone:617-620-8528
Mailing Address - Street 1:608 FRANCESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03442-4314
Mailing Address - Country:US
Mailing Address - Phone:603-255-7070
Mailing Address - Fax:
Practice Address - Street 1:608 FRANCESTOWN ROAD
Practice Address - Street 2:NH ROUTE 47
Practice Address - City:BENNINGTON
Practice Address - State:NH
Practice Address - Zip Code:03442
Practice Address - Country:US
Practice Address - Phone:603-255-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility