Provider Demographics
NPI:1376354092
Name:BRIDGEWAY 360 LLC
Entity type:Organization
Organization Name:BRIDGEWAY 360 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARRAWAY-AMADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-791-5595
Mailing Address - Street 1:305 LEGION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-4036
Mailing Address - Country:US
Mailing Address - Phone:347-791-5595
Mailing Address - Fax:
Practice Address - Street 1:3111 LOS FELIZ BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1519
Practice Address - Country:US
Practice Address - Phone:347-791-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable