Provider Demographics
NPI:1205443371
Name:BRIDGEWATER HEALTH SUPPLIES LLC
Entity type:Organization
Organization Name:BRIDGEWATER HEALTH SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-579-5308
Mailing Address - Street 1:2605 TEXAS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4161
Mailing Address - Country:US
Mailing Address - Phone:903-255-0097
Mailing Address - Fax:516-908-4383
Practice Address - Street 1:2605 TEXAS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4161
Practice Address - Country:US
Practice Address - Phone:903-255-0097
Practice Address - Fax:516-908-4383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGEWATER HEALTH SUPPLIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-23
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies