Provider Demographics
NPI:1194589895
Name:BRIDGE TREATMENT CENTER INC.
Entity type:Organization
Organization Name:BRIDGE TREATMENT CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-368-1293
Mailing Address - Street 1:1300 N. VENTURA RD.
Mailing Address - Street 2:BLD 4
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030
Mailing Address - Country:US
Mailing Address - Phone:805-368-1293
Mailing Address - Fax:888-981-8739
Practice Address - Street 1:1300 N. VENTURA RD.
Practice Address - Street 2:BLD 4
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-368-1293
Practice Address - Fax:888-981-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone