Provider Demographics
NPI:1174051072
Name:BRIDGE HOUSE
Entity type:Organization
Organization Name:BRIDGE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-4865
Mailing Address - Street 1:PO BOX 1040
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-1040
Mailing Address - Country:US
Mailing Address - Phone:801-447-4865
Mailing Address - Fax:801-713-4400
Practice Address - Street 1:235 S 200 E
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2320
Practice Address - Country:US
Practice Address - Phone:801-447-4865
Practice Address - Fax:801-713-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT39298323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility