Provider Demographics
NPI:1043235716
Name:BRIDGEWAY ESTATES
Entity Type:Organization
Organization Name:BRIDGEWAY ESTATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KOESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-9211
Mailing Address - Street 1:103 12TH ST. NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345
Mailing Address - Country:US
Mailing Address - Phone:320-632-2089
Mailing Address - Fax:320-632-2097
Practice Address - Street 1:103 12TH ST. NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345
Practice Address - Country:US
Practice Address - Phone:320-632-2089
Practice Address - Fax:320-632-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330186310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4980473OtherMEDICA