Provider Demographics
NPI:1063400794
Name:BRIDGEWAY, INC.
Entity type:Organization
Organization Name:BRIDGEWAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:908-722-7022
Mailing Address - Street 1:270 ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1919
Mailing Address - Country:US
Mailing Address - Phone:908-722-7022
Mailing Address - Fax:908-725-1822
Practice Address - Street 1:270 ROUTE 28
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-722-7022
Practice Address - Fax:908-725-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061811314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001005OtherHORIZON SUBACUTE PROV #
NJ0075906OtherRESPITE
NJ315182OtherHORIZON SNF PROVIDER #
NJ4499204Medicaid
NJ4499204Medicaid