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General NPI Number Information
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NPI Number | 1144161928
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Entity Type | Organization
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Legal Business Name | BRIDGE CARE COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 42 N 200 E STE 3
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1739
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Country | US
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Telephone | 425-299-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 395 S 170 W
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2980
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRICK DICKSON
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Credential |
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Telephone | 425-299-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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