Healthcare Provider Details

I. General information

NPI: 1124448691
Provider Name (Legal Business Name): BRIDGES FAMILY BASED ADDICTION TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 LAUREL DR
MC MURRAY PA
15317-3219
US

IV. Provider business mailing address

403 LAUREL DR
MC MURRAY PA
15317-3219
US

V. Phone/Fax

Practice location:
  • Phone: 724-986-1538
  • Fax:
Mailing address:
  • Phone: 724-986-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017842
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PAULA J SIERS-BURNS
Title or Position: OWNER/LCSW
Credential: LCSW
Phone: 724-986-1538