Provider Demographics
NPI:1972648988
Name:BRIDGEWAY, INC.
Entity Type:Organization
Organization Name:BRIDGEWAY, INC.
Other - Org Name:UNBAR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:216-688-4130
Mailing Address - Street 1:8301 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1805
Mailing Address - Country:US
Mailing Address - Phone:216-281-2660
Mailing Address - Fax:216-281-5183
Practice Address - Street 1:8301 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1805
Practice Address - Country:US
Practice Address - Phone:216-281-2660
Practice Address - Fax:216-281-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01090OtherUPI
OH0959520Medicaid
OH01090OtherUPI