Provider Demographics
NPI:1053136242
Name:BRIDGE COMMUNITY SERVICES OF CA
Entity type:Organization
Organization Name:BRIDGE COMMUNITY SERVICES OF CA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-869-2747
Mailing Address - Street 1:15065 BRECKINRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5089
Mailing Address - Country:US
Mailing Address - Phone:831-869-2747
Mailing Address - Fax:
Practice Address - Street 1:15065 BRECKINRIDGE AVE
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-5089
Practice Address - Country:US
Practice Address - Phone:831-869-2747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management