Provider Demographics
NPI:1447443999
Name:BRIDGES PROFESSIOANL TREATMENT SERVICES
Entity type:Organization
Organization Name:BRIDGES PROFESSIOANL TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC
Authorized Official - Phone:916-747-7848
Mailing Address - Street 1:1422 28TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6423
Mailing Address - Country:US
Mailing Address - Phone:916-450-0700
Mailing Address - Fax:916-450-0703
Practice Address - Street 1:1422 28TH ST STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6423
Practice Address - Country:US
Practice Address - Phone:916-450-0700
Practice Address - Fax:916-450-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340041AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility