A Bridge Back, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

A BRIDGE BACK, INC.

Practice address

1655 N Arlington Heights Rd # 305
Arlington Heights, IL 60004-3982

Phone

(844) 427-6739

NPI assigned

Dec 21, 2019

Last updated

Nov 14, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Lucien Izraylov, MA, CADC, CODP, QMHP

Title

President

Phone

(847) 877-2440

Specialties & licenses 1

Addresses

Electronic endpoints 1

Tax ID family

A Bridge Back Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• A Bridge Back, Inc.

  • Adult Mental Health Clinic/Center
  • Arlington Heights, IL
  • NPI 1578387544
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dimitry Likterev, DC

  • Neurology Chiropractor
  • Arlington Heights, IL
  • NPI 1124193966
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1093354037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MCHENRY RD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600892428",
            "telephone_number": "844-427-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 N ARLINGTON HEIGHTS RD # 305",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600043982",
            "telephone_number": "844-427-6739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BRIDGE BACK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-21",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A",
        "authorized_official_last_name": "IZRAYLOV",
        "authorized_official_first_name": "LUCIEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-877-2440",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, CADC, CODP, QMHP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lucien@abridgeback.com",
            "affiliation": "N",
            "address_1": "314 McHenry Rd",
            "city": "Buffalo Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600892428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Maria Catherine Gonzales Abarquez, O.T.
• Maria Cristina O. Abarro, RN

• Substance Use Disorder Rehabilitation Clinic/Center in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.