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General NPI Number Information
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NPI Number | 1932795580
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Entity Type | Organization
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Legal Business Name | BRIDGE COMMUNITY SERVICE INC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 964 E STETSON AVE
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City | HEMET
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State | CA
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Zip | 92543-8129
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Country | US
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Telephone | 323-357-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 E CHAPMAN AVE # 335
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City | FULLERTON
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State | CA
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Zip | 92831-3954
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Country | US
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Telephone | 714-458-3976
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MRS. COLETTA FRANCISCUS
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Credential |
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Telephone | 714-458-3976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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