| Bridge Back To Life Center, Inc. | |
|
175 Remsen St Suite 1010 Brooklyn NY 11201-4333 | |
| (718) 852-5552 | |
| (718) 852-5666 |
| Full Name | Bridge Back To Life Center, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 175 Remsen St, Brooklyn, New York |
| Authorized Official Name and Position | Gary Butchen (PRESIDENT) |
| Authorized Official Contact | 5165206600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Back To Life Center, Inc. 4271 Hempstead Tpke Bethpage NY 11714-5708 Ph: (516) 520-6600 | Bridge Back To Life Center, Inc. 175 Remsen St Suite 1010 Brooklyn NY 11201-4333 Ph: (718) 852-5552 |
| NPI Number | 1336566694 |
|---|---|
| Provider Enumeration Date | 03/25/2014 |
| Last Update Date | 11/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336566694 | NPI | - | NPPES |
| 01439087 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 141211343 (New York) | Primary |
| 163WA0400X | Registered Nurse - Addiction (substance Use Disorder) | 141211343 (New York) | Secondary |
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