Provider Demographics
NPI:1902945165
Name:BRIDGES CHILD PLACEMENT AGENCY
Entity Type:Organization
Organization Name:BRIDGES CHILD PLACEMENT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-583-2200
Mailing Address - Street 1:1225 N MAIN ST
Mailing Address - Street 2:#102
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2857
Mailing Address - Country:US
Mailing Address - Phone:719-583-2200
Mailing Address - Fax:719-542-3412
Practice Address - Street 1:1225 N MAIN ST
Practice Address - Street 2:#102
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2857
Practice Address - Country:US
Practice Address - Phone:719-583-2200
Practice Address - Fax:719-542-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01980385H00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered385H00000XRespite Care FacilityRespite Care
Not Answered385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child