Provider Demographics
NPI:1285985929
Name:BRIDGEWOOD LAKE JACKSON, LLC
Entity type:Organization
Organization Name:BRIDGEWOOD LAKE JACKSON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-623-6767
Mailing Address - Street 1:130 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-3258
Mailing Address - Country:US
Mailing Address - Phone:979-285-0300
Mailing Address - Fax:979-285-0338
Practice Address - Street 1:211 E PARKWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5152
Practice Address - Country:US
Practice Address - Phone:281-996-0101
Practice Address - Fax:281-996-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)