Healthcare Provider Details

I. General information

NPI: 1417609934
Provider Name (Legal Business Name): BRIDGE HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 1ST ST N STE 305
SAINT CLOUD MN
56303-1927
US

IV. Provider business mailing address

PO BOX 1676
SAINT CLOUD MN
56302-1676
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-1597
  • Fax: 320-774-0414
Mailing address:
  • Phone: 320-774-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALI ADEN
Title or Position: OWNER
Credential: MA, LPCC
Phone: 612-208-2077