# BRIDGE RESIDENTIAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528822350
- **Authorized official:** WILDINE BURGESS (EXEC ADMIN)
- **Authorized official phone:** (602) 354-9252

## Contact information

- **Practice address:** 7011 S 30TH LN, PHOENIX, AZ 85041-9313
- **Practice address phone:** (602) 354-9252
- **Mailing address:** PO BOX 51382, PHOENIX, AZ 85076-1382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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