| Bridges Emotional Wellness Clinic, Inc | |
|
4235 Flagstaff Cove Fort Wayne IN 46815-4418 | |
| (260) 969-6600 | |
| (260) 969-6601 |
| Full Name | Bridges Emotional Wellness Clinic, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 4235 Flagstaff Cove, Fort Wayne, Indiana |
| Authorized Official Name and Position | Agnes Cecilia Osterholt-polston (PRESIDENT) |
| Authorized Official Contact | 2609696600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridges Emotional Wellness Clinic, Inc 4235 Flagstaff Cove Fort Wayne IN 46815-4418 Ph: (260) 969-6600 | Bridges Emotional Wellness Clinic, Inc 4235 Flagstaff Cove Fort Wayne IN 46815-4418 Ph: (260) 969-6600 |
| NPI Number | 1437375888 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 07/01/2008 |
| Medicare PECOS PAC ID | 0244219046 |
|---|---|
| Medicare Enrollment ID | O20040715000874 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437375888 | NPI | - | NPPES |
| 200373680 | Medicaid | IN |
| Provider Name | Agnes Cecilia Osterholt Polston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255346011 PECOS PAC ID: 9931188752 Enrollment ID: I20040715001017 |
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