Provider Demographics
NPI:1366433278
Name:BRIDGEWAY PSYCHIATRIC CENTER, INC.
Entity type:Organization
Organization Name:BRIDGEWAY PSYCHIATRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:337-785-8003
Mailing Address - Street 1:3451 5TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2127
Mailing Address - Country:US
Mailing Address - Phone:337-562-0211
Mailing Address - Fax:337-562-0212
Practice Address - Street 1:3451 5TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2127
Practice Address - Country:US
Practice Address - Phone:337-562-0211
Practice Address - Fax:337-562-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1152013Medicaid
LA61404OtherBLUE CROSS BLUE SHIELD
LA1152013Medicaid