Provider Demographics
NPI:1992458616
Name:BRIDGE YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:BRIDGE YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE AND COMPLIANCE DI
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:MLYNEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-485-3091
Mailing Address - Street 1:721 S QUENTIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6778
Mailing Address - Country:US
Mailing Address - Phone:847-485-3091
Mailing Address - Fax:847-359-7525
Practice Address - Street 1:721 S QUENTIN RD STE 103
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6778
Practice Address - Country:US
Practice Address - Phone:847-485-3091
Practice Address - Fax:847-359-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health