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General NPI Number Information
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NPI Number | 1356163299
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Entity Type | Organization
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Legal Business Name | MENDING BRIDGES LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 430 N STATE COLLEGE BLVD UNIT A AND C
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City | ANAHEIM
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State | CA
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Zip | 92806-2916
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Country | US
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Telephone | 657-216-4133
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Fax |
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Provider Business Mailing Address
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Address Line | 1082 FERNLEAF LN
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City | CORONA
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State | CA
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Zip | 92881-3677
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Country | US
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Telephone | 657-216-4133
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MIGUEL URETA JR.
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Credential |
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Telephone | 657-216-4133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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