Healthcare Provider Details

I. General information

NPI: 1023310430
Provider Name (Legal Business Name): CRESTWOOD BAKERSFIELD BRIDGE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 EUCALYPTUS DR
BAKERSFIELD CA
93306
US

IV. Provider business mailing address

6711 EUCALYPTUS DR
BAKERSFIELD CA
93306
US

V. Phone/Fax

Practice location:
  • Phone: 661-363-6711
  • Fax:
Mailing address:
  • Phone: 661-363-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number157206291
License Number StateCA

VIII. Authorized Official

Name: MICHELLE SMITH
Title or Position: EXECUTIVE DIRECTOR AR AND REIMB.
Credential:
Phone: 209-955-2364