| Bridges Community Health Inc. | |
|
210 S 5th St Cottage Grove OR 97424-2105 | |
| (541) 321-2103 | |
| (541) 255-1412 |
| Full Name | Bridges Community Health Inc. |
|---|---|
| Speciality | Counselor |
| Location | 210 S 5th St, Cottage Grove, Oregon |
| Authorized Official Name and Position | Tracey Kenyon (MANAGER) |
| Authorized Official Contact | 5412551411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridges Community Health Inc. 1711 Willamette St Ste 301 #140 Eugene OR 97401-4593 Ph: (541) 255-1411 | Bridges Community Health Inc. 210 S 5th St Cottage Grove OR 97424-2105 Ph: (541) 321-2103 |
| NPI Number | 1093249542 |
|---|---|
| Provider Enumeration Date | 04/11/2017 |
| Last Update Date | 06/05/2023 |
| Certification Date | 06/05/2023 |
| Medicare PECOS PAC ID | 0547502783 |
|---|---|
| Medicare Enrollment ID | O20190508001947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093249542 | NPI | - | NPPES |
| 500767760 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Karla G Marvich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649522178 PECOS PAC ID: 1052614245 Enrollment ID: I20170915001651 |
| Provider Name | Teresa R Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164078192 PECOS PAC ID: 4587094958 Enrollment ID: I20200427000804 |
| Provider Name | Ambyr Rose Stores |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730545211 PECOS PAC ID: 4486067584 Enrollment ID: I20210111000750 |
| Provider Name | Mary Cameron Leyda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619534146 PECOS PAC ID: 7618371287 Enrollment ID: I20210803003793 |
| Provider Name | Linda M Willow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598968299 PECOS PAC ID: 2769888999 Enrollment ID: I20210913003378 |
| Provider Name | Kara Lynn Petredis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912675786 PECOS PAC ID: 2264819747 Enrollment ID: I20220523002068 |
| Provider Name | Victoria Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467937276 PECOS PAC ID: 9537536818 Enrollment ID: I20221028001194 |
| Provider Name | Bronwen A Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376395004 PECOS PAC ID: 8729420062 Enrollment ID: I20240531001438 |
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