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General NPI Number Information
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NPI Number | 1639993702
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Entity Type | Organization
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Legal Business Name | BRIDGE TO WELLNESS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 5505 W 123RD ST STE 2000
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City | SAVAGE
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State | MN
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Zip | 55378-5505
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Country | US
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Telephone | 612-460-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 2532 59TH ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-8745
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Country | US
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Telephone | 507-358-5276
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AHMEDNUR ALI
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Credential |
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Telephone | 612-460-5056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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