Provider Demographics
NPI:1457647232
Name:BRIDGEVIEW HOUSING CORPORATION
Entity Type:Organization
Organization Name:BRIDGEVIEW HOUSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-323-2980
Mailing Address - Street 1:121 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1263
Mailing Address - Country:US
Mailing Address - Phone:217-323-2980
Mailing Address - Fax:217-323-3731
Practice Address - Street 1:7 BRIDGEVIEW
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1069
Practice Address - Country:US
Practice Address - Phone:217-323-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASS COUNTY MENTAL HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health