Provider Demographics
NPI:1336234087
Name:BRIDGEWAY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGEWAY HEALTH SERVICES LLC
Other - Org Name:RELIANT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-390-7733
Mailing Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5752
Mailing Address - Country:US
Mailing Address - Phone:817-878-4277
Mailing Address - Fax:817-878-4303
Practice Address - Street 1:3880 HULEN ST STE 670
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7274
Practice Address - Country:US
Practice Address - Phone:817-878-4277
Practice Address - Fax:817-878-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014989251E00000X
TX=========364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001228Medicaid
TX458178Medicare Oscar/Certification
TX451700OtherHOSPICE
TX458178Medicare ID - Type UnspecifiedHOME HEALTH
TX458178Medicare Oscar/Certification