1952577827 NPI number — STEPHANIE E BRIDGES RNC LADC LMT

Table of content: STEPHANIE E BRIDGES RNC LADC LMT (NPI 1952577827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952577827 NPI number — STEPHANIE E BRIDGES RNC LADC LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGES
Provider First Name:
STEPHANIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNC LADC LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952577827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 422
Provider Second Line Business Mailing Address:
ACADIA HOSPITAL CORP
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04402-0422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-6100
Provider Business Mailing Address Fax Number:
207-973-6109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
268 STILLWATER AVENUE
Provider Second Line Business Practice Location Address:
ACADIA HOSPITAL CORP
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-6100
Provider Business Practice Location Address Fax Number:
207-973-6109
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LC4252 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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