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General NPI Number Information
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NPI Number | 1780952770
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Entity Type | Organization
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Legal Business Name | BRIDGES TO RECOVERY II LLC
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1820 SAN VICENTE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90402-2309
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Country | US
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Telephone | 310-459-0613
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Fax | 310-573-7092
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Provider Business Mailing Address
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Address Line | 1460 SAN REMO DR
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-2737
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Country | US
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Telephone | 310-459-0613
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Fax | 310-573-7092
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FREDERIK VILHELM SCHULIN
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Credential |
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Telephone | 310-459-0613
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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 | 196601269
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License Number State | CA
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