| Bridge Residential Home Llc | |
|
7343 W Maldonado Rd Laveen AZ 85339-7001 | |
| (602) 354-9252 | |
| Not Available |
| Full Name | Bridge Residential Home Llc |
|---|---|
| Speciality | Psychiatric Residential Treatment Facility |
| Location | 7343 W Maldonado Rd, Laveen, Arizona |
| Authorized Official Name and Position | Wildine Burgess (EXEC ADMIN) |
| Authorized Official Contact | 6023549252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Residential Home Llc Po Box 51382 Phoenix AZ 85076-1382 Ph: () - | Bridge Residential Home Llc 7343 W Maldonado Rd Laveen AZ 85339-7001 Ph: (602) 354-9252 |
| NPI Number | 1114781945 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 02/12/2024 |
| Certification Date | 02/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114781945 | NPI | - | NPPES |
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