Provider Demographics
NPI:1619760717
Name:MERCY BRIDGE RESIDENTIAL TREATMENT LLC
Entity type:Organization
Organization Name:MERCY BRIDGE RESIDENTIAL TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEWDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-644-4312
Mailing Address - Street 1:5880 SW 206TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-3743
Mailing Address - Country:US
Mailing Address - Phone:616-644-4312
Mailing Address - Fax:
Practice Address - Street 1:1050 SW 160TH AVE APT 338
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5017
Practice Address - Country:US
Practice Address - Phone:616-644-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness