Organization
BRIDGE BACK TO LIFE CENTER, INC.
Active
Organization
BRIDGE BACK TO LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BUTCHEN LCSW-R, SAP (PRESIDENT)
(516) 520-6600
Entity
Organization
Contact information
Practice address
4271 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5708
(516) 520-6600
(212) 520-6750
Mailing address
4271 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5708
(516) 520-6600
(516) 520-6750
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
160310678
NY
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
160310678
NY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01439087
—
NY
Enumeration date
03/19/2014
Last updated
11/07/2018
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