Bridge Residential Support Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BRIDGE RESIDENTIAL SUPPORT SERVICES LLC

Practice address

10902 Jaynes PLZ
Omaha, NE 68164-4411

Phone

(207) 409-4774

NPI assigned

Jul 23, 2022

Organization subpart

No

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

Authorized official

Name

Idris Naney, DSP

Title

Ceo

Phone

(207) 409-4774

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1658534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658534400000",
    "number": "1497480362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10902 JAYNES PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681644411",
            "telephone_number": "207-409-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10902 JAYNES PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681644411",
            "telephone_number": "207-409-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE RESIDENTIAL SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-23",
        "last_updated": "2022-07-23",
        "certification_date": "2022-07-23",
        "status": "A",
        "authorized_official_last_name": "NANEY",
        "authorized_official_first_name": "IDRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-409-4774",
        "authorized_official_credential": "DSP"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Brichacek, OTRL
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• Lauren C Brickett, PA
• Katelynn Brickey
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• Bridge to Wonderland, LLC
• Julia A Bridge, MD
• Brittney Bridgeford
• Patricia Bridgeman

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Omaha, NE
• Providers in Omaha, NE by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2022; 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.