| New Roots Bridgeway Llc | |
|
4208 E Central Ave Wichita KS 67208-3822 | |
| (316) 351-8280 | |
| Not Available |
| Full Name | New Roots Bridgeway Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4208 E Central Ave, Wichita, Kansas |
| Authorized Official Name and Position | Ashlea Nicholson (CEO) |
| Authorized Official Contact | 7853420437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Roots Bridgeway Llc 4208 E Central Ave Wichita KS 67208-3822 Ph: () - | New Roots Bridgeway Llc 4208 E Central Ave Wichita KS 67208-3822 Ph: (316) 351-8280 |
| NPI Number | 1174264808 |
|---|---|
| Provider Enumeration Date | 04/05/2022 |
| Last Update Date | 06/08/2022 |
| Certification Date | 06/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174264808 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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