Provider Demographics
NPI:1063255024
Name:BRIDGE CENTERS LLC
Entity type:Organization
Organization Name:BRIDGE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIFATAH
Authorized Official - Middle Name:ABDULLAHI
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-492-1031
Mailing Address - Street 1:4310 N WOODGATE LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2277
Mailing Address - Country:US
Mailing Address - Phone:952-492-1031
Mailing Address - Fax:
Practice Address - Street 1:4310 N WOODGATE LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2277
Practice Address - Country:US
Practice Address - Phone:952-492-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty