Healthcare Provider Details

I. General information

NPI: 1902945165
Provider Name (Legal Business Name): BRIDGES CHILD PLACEMENT AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N MAIN ST #102
PUEBLO CO
81003-2857
US

IV. Provider business mailing address

1225 N MAIN ST #102
PUEBLO CO
81003-2857
US

V. Phone/Fax

Practice location:
  • Phone: 719-583-2200
  • Fax: 719-542-3412
Mailing address:
  • Phone: 719-583-2200
  • Fax: 719-542-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number01980
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number01980
License Number StateCO

VIII. Authorized Official

Name: MR. WAYNE LEE HINKLE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 719-583-2200