MEDICARE: BRIDGES RECOVERY CENTER

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	324500000X	Substance Abuse Rehabilitation Facility	000272062700017	CA

General Provider Information

NPI Number	:	1851715452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES RECOVERY CENTER

Provider Business Mailing Address
First Line	:	15214 LEADWELL ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-1735
Country	:	US
Telephone Number	:	818-465-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	15214 LEADWELL ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-1735
Country	:	US
Telephone Number	:	818-465-3988
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEORGE BOYADZHYAN
Credential	:
Telephone Number	:	818-465-3988

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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Directions to “BRIDGES RECOVERY CENTER ” Practice Location

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