Basic Information
| Provider Information | |||||||||
| NPI: | 1710612304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTBRIDGE OUTPATIENT SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031043550 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 660 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031043550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036344446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2022 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROJECT & QA MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6036344446 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTBRIDGE, INC. | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.