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General NPI Number Information
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NPI Number | 1023310430
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Entity Type | Organization
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Legal Business Name | CRESTWOOD BAKERSFIELD BRIDGE PROGRAM
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 6711 EUCALYPTUS DR
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City | BAKERSFIELD
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State | CA
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Zip | 93306
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Country | US
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Telephone | 661-363-6711
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Fax |
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Provider Business Mailing Address
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Address Line | 6711 EUCALYPTUS DR
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City | BAKERSFIELD
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State | CA
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Zip | 93306
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Country | US
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Telephone | 661-363-6711
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR AR AND REIMB.
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Name | MICHELLE SMITH
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Credential |
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Telephone | 209-955-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 157206291
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License Number State | CA
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