Provider Demographics
NPI:1962995993
Name:THE BRIDGE HOME FOR CHILDREN
Entity type:Organization
Organization Name:THE BRIDGE HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-8711
Mailing Address - Street 1:6033 SWOPE PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-4461
Mailing Address - Country:US
Mailing Address - Phone:816-333-8711
Mailing Address - Fax:816-333-8799
Practice Address - Street 1:6033 SWOPE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-4461
Practice Address - Country:US
Practice Address - Phone:816-333-8711
Practice Address - Fax:816-333-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children