Healthcare Provider Details

I. General information

NPI: 1740054352
Provider Name (Legal Business Name): BRIDGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W GRAND AVE
ARTESIA NM
88210-1937
US

IV. Provider business mailing address

3302 W RICHEY AVE
ARTESIA NM
88210-9448
US

V. Phone/Fax

Practice location:
  • Phone: 575-365-6317
  • Fax:
Mailing address:
  • Phone: 575-365-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BOB MAYBERRY
Title or Position: REGISTERED AGENT/TREASURE
Credential:
Phone: 575-365-6317