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Organization
BRIDGE RESIDENTIAL LLC
Active
Organization
BRIDGE RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILDINE BURGESS (EXEC ADMIN)
(602) 354-9252
Entity
Organization
Contact information
Practice address
7011 S 30TH LN, PHOENIX, AZ 85041-9313
(602) 354-9252
Mailing address
PO BOX 51382, PHOENIX, AZ 85076-1382
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
NULL
103TP2701X
Group Psychotherapy Psychologist
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
NULL
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
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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