MEDICARE: BRIDGE HEALING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1417609934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE HEALING CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 1676
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56302-1676
Country	:	US
Telephone Number	:	320-774-1597
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 1ST ST N STE 305
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	320-774-1597
Fax Number	:	320-774-0414

Authorized Official
Title or Position	:	OWNER
Name	:	ALI ADEN
Credential	:	MA, LPCC
Telephone Number	:	612-208-2077

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	03/03/2026

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