Organization
A BRIDGE BACK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUCIEN IZRAYLOV MA, CADC, CODP, QMHP (PRESIDENT)
(847) 877-2440
Entity
Organization
Contact information
Practice address
1655 N ARLINGTON HEIGHTS RD # 305, ARLINGTON HEIGHTS, IL 60004-3982
(844) 427-6739
Mailing address
314 MCHENRY RD, BUFFALO GROVE, IL 60089-2428
(844) 427-6739
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/21/2019
Last updated
11/14/2024
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