Provider Demographics
NPI:1194113209
Name:NORTHBRIDGE LLC
Entity type:Organization
Organization Name:NORTHBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-770-0495
Mailing Address - Street 1:PO BOX 231430
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1835 BRAGAW ST
Practice Address - Street 2:SUITE #190
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3469
Practice Address - Country:US
Practice Address - Phone:907-770-0495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health