1083468573 NPI number — BRIDGES AFH INC

Table of content: (NPI 1083468573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083468573 NPI number — BRIDGES AFH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGES AFH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1083468573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15505 NE 89TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682-3594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-600-4059
Provider Business Mailing Address Fax Number:
360-258-1931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14119 NE 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-258-1103
Provider Business Practice Location Address Fax Number:
360-258-1931
Provider Enumeration Date:
04/12/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRIDGES
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-260-3956

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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