NPIMap

Organization Active NPI

Bridge Back to Life Center Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1922336106
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
111111254 Issued in NY
Legal business name
BRIDGE BACK TO LIFE CENTER INC
Practice address
2857 W 8TH St
Brooklyn, NY 11224-3604
Phone
(718) 265-4200
Fax
(718) 265-8536
NPI assigned
Nov 25, 2009
Last updated
Nov 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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

Authorized official

Name
Gary Butchen
Title
President
Phone
(212) 679-4960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 111111254 NY Primary

Addresses

Primary practice location

2857 W 8TH St
Brooklyn, NY 11224-3604

Mailing address

2857 W 8TH St
Brooklyn, NY 11224-3604
Phone (718) 265-4200

Other identifiers 1

IdentifierTypeStateIssuer
075282OtherNYLMSW

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

Locations

2857 W 8th St
Brooklyn, NY 11224
Phone (718) 265-4200

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1922336106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2857 W 8TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112243604",
            "telephone_number": "718-265-4200",
            "fax_number": "718-265-8536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2857 W 8TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112243604",
            "telephone_number": "718-265-4200",
            "fax_number": "718-265-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE BACK TO LIFE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-25",
        "last_updated": "2009-11-25",
        "status": "A",
        "authorized_official_last_name": "BUTCHEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-679-4960"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NY",
            "license": "111111254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW",
            "identifier": "075282",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; 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.