Provider Demographics
NPI:1831506658
Name:CSN- BRIDGES
Entity type:Organization
Organization Name:CSN- BRIDGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:AOD CERIFIFCATE
Authorized Official - Phone:707-575-0979
Mailing Address - Street 1:1410 GUERNEVILLE RD ,SUITE 14
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7231
Mailing Address - Country:US
Mailing Address - Phone:707-575-0979
Mailing Address - Fax:707-573-6968
Practice Address - Street 1:1115 DETURK AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5803
Practice Address - Country:US
Practice Address - Phone:707-484-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness