Bridge Light Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

BRIDGE LIGHT RECOVERY LLC

Practice address

7365 Howard LN Apt 236
Eden Prairie, MN 55346-3038

Phone

(612) 598-5484

NPI assigned

Sep 28, 2026

Last updated

Sep 28, 2026By 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

Faduma Mohamed

Title

Owner

Phone

(612) 598-5484

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1790553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790553600000",
    "number": "1861305039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7365 HOWARD LN APT 236",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553463038",
            "telephone_number": "612-598-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7365 HOWARD LN APT 236",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553463038",
            "telephone_number": "612-598-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE LIGHT RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-28",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-27",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "FADUMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-598-5484"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Eden Prairie, MN
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• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.