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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
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
323P00000X
Psychiatric Residential Treatment Facility
Primary
324500000X
Substance Abuse Rehabilitation Facility
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
02/12/2024
Last updated
02/12/2024
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