Provider Demographics
NPI:1699154286
Name:BRIDGEWAY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BRIDGEWAY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAHOMA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NASYM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-482-4236
Mailing Address - Street 1:3508 WHISPERING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-428-4236
Mailing Address - Fax:
Practice Address - Street 1:3508 WHISPERING WOODS DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1154
Practice Address - Country:US
Practice Address - Phone:314-482-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care