Organization
YOUTH BRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY RODRIGUEZ (MHPP)
(479) 282-9492
Entity
Organization
Contact information
Practice address
250 E CENTERTON BLVD, CENTERTON, AR 72719-9240
(479) 795-1802
Mailing address
250 E. CENTERTON BLVD., CENTERTON, AR 72758
(479) 795-1802
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
12/23/2014
Last updated
12/23/2014
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