Provider Demographics
NPI:1356346274
Name:BRIDGEWATER HOME, INC.
Entity type:Organization
Organization Name:BRIDGEWATER HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-828-2550
Mailing Address - Street 1:302 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1712
Mailing Address - Country:US
Mailing Address - Phone:540-828-2550
Mailing Address - Fax:540-828-2668
Practice Address - Street 1:302 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1712
Practice Address - Country:US
Practice Address - Phone:540-828-2550
Practice Address - Fax:540-828-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2520314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-E008Medicaid
VA49-E008Medicaid