Provider Demographics
NPI:1154466555
Name:THE BRIDGE CENTER
Entity type:Organization
Organization Name:THE BRIDGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:775-857-2999
Mailing Address - Street 1:1201 CORPORATE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-857-2999
Mailing Address - Fax:775-857-2998
Practice Address - Street 1:1201 CORPORATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-857-2999
Practice Address - Fax:775-857-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV410101YA0400X
NV1104 I101YA0400X
NV625101YA0400X
NV747101YA0400X
NV00987-I101YA0400X
NV01015-I101YA0400X
NV714P-S104100000X
NV2815-C1041C0700X
NV0370106H00000X
NVR05380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510922Medicaid
NV100510921Medicaid