Provider Demographics
NPI:1114317088
Name:BRIDGEWAY SENIOR LIVING LLC
Entity type:Organization
Organization Name:BRIDGEWAY SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUJUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-217-1014
Mailing Address - Street 1:111 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2674
Mailing Address - Country:US
Mailing Address - Phone:630-766-5800
Mailing Address - Fax:630-766-5473
Practice Address - Street 1:111 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2674
Practice Address - Country:US
Practice Address - Phone:630-766-5800
Practice Address - Fax:630-766-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0048819314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility