Provider Demographics
NPI:1962473306
Name:THE BRIDGEWAY, LLC
Entity Type:Organization
Organization Name:THE BRIDGEWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SR VP
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:21 BRIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9514
Mailing Address - Country:US
Mailing Address - Phone:501-771-1500
Mailing Address - Fax:
Practice Address - Street 1:21 BRIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9514
Practice Address - Country:US
Practice Address - Phone:501-771-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2559283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105312125Medicaid
AR57226OtherBLUE CROSS/BLUESHIELD OF AR
AR105312125Medicaid
AR57226Medicare PIN