Organization
CSN- BRIDGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON MARIE SHIELDS AOD CERIFIFCATE (PROGRAM MANAGER)
(707) 575-0979
Entity
Organization
Contact information
Practice address
1115 DETURK AVE, SANTA ROSA, CA 95404-5803
(707) 484-1326
Mailing address
1410 GUERNEVILLE RD ,SUITE 14, SANTA ROSA, CA 95403-7231
(707) 575-0979
(707) 573-6968
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/14/2014
Last updated
07/17/2014
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