Healthcare Provider Details

I. General information

NPI: 1740518133
Provider Name (Legal Business Name): BRIDGES HABILITATION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 HIGHWAY 150 S STE 2
EVANSTON WY
82930-5377
US

IV. Provider business mailing address

PO BOX 1642
EVANSTON WY
82931-1642
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-0664
  • Fax: 307-789-1902
Mailing address:
  • Phone: 307-789-0664
  • Fax: 307-789-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID M. CANEN
Title or Position: CEO
Credential:
Phone: 307-789-0664