Provider Demographics
NPI:1487172110
Name:BRIDGES INTERNATIONAL CENTERS FOR RECOVERY AND REENTRY, INC.
Entity type:Organization
Organization Name:BRIDGES INTERNATIONAL CENTERS FOR RECOVERY AND REENTRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FAMILY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, IMH
Authorized Official - Phone:407-218-4791
Mailing Address - Street 1:2145 METROCENTER BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7642
Mailing Address - Country:US
Mailing Address - Phone:407-218-4791
Mailing Address - Fax:
Practice Address - Street 1:2145 METROCENTER BLVD STE 350
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-218-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty