Provider Demographics
NPI:1396420006
Name:BRIDGES COMMUNITY HEALTH
Entity type:Organization
Organization Name:BRIDGES COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BREHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-642-1841
Mailing Address - Street 1:947 RYE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3295
Mailing Address - Country:US
Mailing Address - Phone:757-642-1841
Mailing Address - Fax:
Practice Address - Street 1:3018 VICTORY BLVD STE B1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-1828
Practice Address - Country:US
Practice Address - Phone:757-642-1841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health