Provider Demographics
NPI:1043410616
Name:BRIDGEWAY HOSPICE, INC.
Entity Type:Organization
Organization Name:BRIDGEWAY HOSPICE, INC.
Other - Org Name:BRIDGEWAY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:770-389-8784
Mailing Address - Street 1:1041 THURMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1420
Mailing Address - Country:US
Mailing Address - Phone:770-389-8784
Mailing Address - Fax:770-389-8523
Practice Address - Street 1:1041 THURMAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1420
Practice Address - Country:US
Practice Address - Phone:770-389-8784
Practice Address - Fax:770-389-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based