YOUTH BRIDGE, INC. (NPI# 1699803577) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699803577 |
| Entity Type | Organization |
| Organization Name | YOUTH BRIDGE, INC. |
| Other Organization Name | BURRELL BEHAVIORAL HEALTH |
| Practice Address |
4171 N Crossover Rd Fayetteville AR 72703-4591 |
| Practice Telephone | 4795759471 |
| Practice Fax Number | 4795219940 |
| Mailing Telephone | 4795759471 |
| Mailing Fax Number | 4795219940 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-10-20 |
| Authorized Official Name | JENNIFER LYNN GAGNON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4177615012 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | COUNCIL ON ACCREDITATION | 2055 | 01 |
| AR | DHHS | 100028894 | 01 |
| AR | OADAP | D12530 | 01 |
| Other Name | Type Code |
|---|---|
| Burrell Behavioral Health | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 114 E Crandall Ave Ste B, Harrison, AR 726013628 | 8707418484 | 8707414088 |
| 3895 George Anderson Rd, Springdale, AR 727648251 | 4795211532 | 4795219940 |
| 707 N Cardinal Dr Ste 7, Mountain Home, AR 726533274 | 8704255644 | 8704242201 |
| 707 N Cardinal Dr Ste 7, Mountain Home, AR 726533274 | ||
| 707 N Cardinal Dr, Suite 7, Mountain Home, AR 72653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669762431 | Youth Bridge, Inc. | Case Management | 107 E Crandall Ave, Harrison, AR 72601-3629 | 2011-04-14 |
| 1891050621 | Youth Bridge, Inc. | Community/Behavioral Health | 3715 N Business Dr, Ste 104, Fayetteville, AR 72703-5204 | 2012-07-09 |
| Street Address |
4171 N CROSSOVER RD |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-4591 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164933453 | Pamela R Ramsfield | Social Worker | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-10-13 |
| 1821514654 | Jenny Martinez | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-08-14 |
| 1124543707 | Ethan Paul Cole | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-08-04 |
| 1578088159 | Mari Elizabeth Wetzel | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-08-04 |
| 1093235277 | Nisha Thapa Bista | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-06-20 |
| 1023548666 | Kelsey Struckhoff | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-06-15 |
| 1003346073 | Jocelyn Stephanie Calderon | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-06-13 |
| 1558899120 | Shawn Patrick Hayes | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-05-26 |
| 1649710633 | Catarina Wolfe | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2017-02-24 |
| 1366987521 | Michelle Hamrick | Case Manager/Care Coordinator | 4171 N Crossover Rd, Fayetteville, AR 72703-4591 | 2016-12-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528696796 | Faith Springs Eternal (fase), Pllc | Community/Behavioral Health | 2537 Gray Goose Loop, Fayetteville, NC 28306-3550 | 2020-04-01 |
| 1134684392 | Carolina Outreach, LLC | Community/Behavioral Health | 324 Person St, Fayetteville, NC 28301-5736 | 2019-02-01 |
| 1124591094 | Changing Places Therapeutic Center, Company | Community/Behavioral Health | 1044 Bragg Blvd Ste B, Fayetteville, NC 28301-4512 | 2019-01-03 |
| 1538632518 | Benevolent Counseling, Pllc | Community/Behavioral Health | 2929 Breezewood Ave Ste 203, Fayetteville, NC 28303-5357 | 2019-01-02 |
| 1386128031 | Alexander Youth Network | Community/Behavioral Health | 2115 Hope Mills Rd, Fayetteville, NC 28304-4256 | 2018-09-19 |
| 1811497639 | Alexander Youth Network | Community/Behavioral Health | 1608 Camden Rd, Rooms #16 & #17, Fayetteville, NC 28306-1734 | 2018-02-19 |
| 1629578851 | Jeanette Bostick | Community/Behavioral Health | 1628 Turkey Run, Fayetteville, NC 28312-7643 | 2018-02-14 |
| 1942718325 | A Mother's Pursuit, LLC | Community/Behavioral Health | 511 N Reilly Rd Ste A, Fayetteville, NC 28303-2440 | 2018-01-18 |
| 1992213771 | Deborah A Atkinson Phd Pllc | Community/Behavioral Health | 501 Executive Pl Ste B, Fayetteville, NC 28305-5391 | 2018-01-16 |
| 1841739455 | Aci Support Specialists | Community/Behavioral Health | 414 Snowhill Rd, Fayetteville, NC 28306-9073 | 2017-02-15 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.