MEDICARE: BRIDGE YOUTH & FAMILY SERVICES

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	251S00000X	Community/Behavioral Health Agency	026714-11	IL

General Provider Information

NPI Number	:	1427128750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE YOUTH & FAMILY SERVICES

Provider Business Mailing Address
First Line	:	721 S QUENTIN RD
Second Line	:	SUITE 103
City	:	PALATINE
State	:	IL
Zip	:	60067-6778
Country	:	US
Telephone Number	:	847-359-7490
Fax Number	:	847-359-7525

Provider Business Practice Location Address
First Line	:	721 S QUENTIN RD
Second Line	:	SUITE 103
City	:	PALATINE
State	:	IL
Zip	:	60067-6778
Country	:	US
Telephone Number	:	847-359-7490
Fax Number	:	847-359-7525

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PETER D CUNNEEN
Credential	:
Telephone Number	:	847-359-7490

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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