Provider Demographics
NPI:1184469082
Name:BRIDGEWAY OF BENSENVILLE INDEPENDENT LIVING LLC
Entity type:Organization
Organization Name:BRIDGEWAY OF BENSENVILLE INDEPENDENT LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF A/R
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR DUJUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-217-1014
Mailing Address - Street 1:303 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3515
Mailing Address - Country:US
Mailing Address - Phone:630-766-0605
Mailing Address - Fax:630-766-0752
Practice Address - Street 1:303 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3515
Practice Address - Country:US
Practice Address - Phone:630-766-0605
Practice Address - Fax:630-766-0752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGEWAY OF BENSENVILLE INDEPENDENT LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)