Provider Demographics
NPI:1396112173
Name:BRIDGEWOOD VILLAGE ON SC TRS, LLC
Entity type:Organization
Organization Name:BRIDGEWOOD VILLAGE ON SC TRS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-996-0101
Mailing Address - Street 1:6363 WOODWAY DR
Mailing Address - Street 2:#410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1735
Mailing Address - Country:US
Mailing Address - Phone:281-996-0101
Mailing Address - Fax:281-996-1141
Practice Address - Street 1:20305 HOLZWARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-5582
Practice Address - Country:US
Practice Address - Phone:281-257-2299
Practice Address - Fax:281-996-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility