Provider Demographics
NPI:1699299313
Name:BRIDGES HABILITATION SERVICES, INC.
Entity type:Organization
Organization Name:BRIDGES HABILITATION SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-0664
Mailing Address - Street 1:PO BOX 1642
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-1642
Mailing Address - Country:US
Mailing Address - Phone:307-789-0664
Mailing Address - Fax:
Practice Address - Street 1:1425 HIGHWAY 150 S STE 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5377
Practice Address - Country:US
Practice Address - Phone:307-789-0664
Practice Address - Fax:307-222-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115726400Medicaid