NPIMap

Organization Active NPI

Bridge Back to Life Center, Inc.

  • Clinical Social Worker
  • Bethpage, NY
National Provider Identifier
1265859078
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
160310678 Issued in NY
Legal business name
BRIDGE BACK TO LIFE CENTER, INC.
Practice address
4271 Hempstead Tpke
Bethpage, NY 11714-5708
Phone
(516) 520-6600
Fax
(212) 520-6750
NPI assigned
Mar 19, 2014
Last updated
Nov 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Authorized official

Name
Mr. Gary Butchen, LCSW-R, SAP
Title
President
Phone
(516) 520-6600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Clinical Social Worker 1041C0700X 160310678 NY Primary
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X 160310678 NY

Addresses

Primary practice location

4271 Hempstead Tpke
Bethpage, NY 11714-5708

Mailing address

4271 Hempstead Tpke
Bethpage, NY 11714-5708
Phone (516) 520-6600

Other identifiers 1

IdentifierTypeStateIssuer
01439087MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Bridge Back to Life Center Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1265859078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4271 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145708",
            "telephone_number": "516-520-6600",
            "fax_number": "516-520-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4271 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145708",
            "telephone_number": "516-520-6600",
            "fax_number": "212-520-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE BACK TO LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "BUTCHEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-520-6600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-R, SAP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "160310678",
            "primary": true
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "160310678",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01439087",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.