Provider Demographics
NPI:1336292887
Name:BRIDGEWELL
Entity Type:Organization
Organization Name:BRIDGEWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:339-883-2166
Mailing Address - Street 1:471 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940
Mailing Address - Country:US
Mailing Address - Phone:339-883-2166
Mailing Address - Fax:339-883-2187
Practice Address - Street 1:162 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3133
Practice Address - Country:US
Practice Address - Phone:339-883-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312022Medicaid
MA1312049Medicaid
MA1308599Medicaid
MA1307673Medicaid
MA1308572Medicaid
MAM20360Medicare ID - Type Unspecified
MA1312022Medicaid