Provider Demographics
NPI:1922545300
Name:BRIDGEWOOD INC.
Entity Type:Organization
Organization Name:BRIDGEWOOD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-493-2094
Mailing Address - Street 1:8011 N POINT BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3879
Mailing Address - Country:US
Mailing Address - Phone:336-727-3592
Mailing Address - Fax:
Practice Address - Street 1:8011 N POINT BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3879
Practice Address - Country:US
Practice Address - Phone:336-727-3592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC261QM0801XMedicaid