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Organization
BRIDGE RESIDENTIAL HOME LLC
Active
Organization
BRIDGE RESIDENTIAL HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILDINE BURGESS (EXEC ADMIN)
(602) 354-9252
Entity
Organization
Contact information
Practice address
7343 W MALDONADO RD, LAVEEN, AZ 85339-7001
(602) 354-9252
Mailing address
PO BOX 51382, PHOENIX, AZ 85076-1382
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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