Healthcare Provider Details

I. General information

NPI: 1093249542
Provider Name (Legal Business Name): BRIDGES COMMUNITY HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BIRCH AVE
COTTAGE GROVE OR
97424-1417
US

IV. Provider business mailing address

1976 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-1411
  • Fax: 541-255-1412
Mailing address:
  • Phone: 541-255-1411
  • Fax: 541-255-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACEY KENYON
Title or Position: MANAGER
Credential:
Phone: 541-255-1411