Provider Demographics
NPI:1497099147
Name:BRIDGEWOOD NURSING AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:BRIDGEWOOD NURSING AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-601-1450
Mailing Address - Street 1:6340 S 3000 E
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3540
Mailing Address - Country:US
Mailing Address - Phone:801-601-1450
Mailing Address - Fax:801-996-3601
Practice Address - Street 1:125 BYRD AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4015
Practice Address - Country:US
Practice Address - Phone:920-725-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDURO HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service