Provider Demographics
NPI:1457379018
Name:BRIDGEWATER CENTER FOR REHABILITATION & NURSING LLC
Entity Type:Organization
Organization Name:BRIDGEWATER CENTER FOR REHABILITATION & NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-371-8100
Mailing Address - Street 1:1 HILLCREST CENTER DRIVE
Mailing Address - Street 2:SUITE #325
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3740
Mailing Address - Country:US
Mailing Address - Phone:845-371-8100
Mailing Address - Fax:845-371-0010
Practice Address - Street 1:159-163 FRONT STREET
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-3103
Practice Address - Country:US
Practice Address - Phone:607-722-7225
Practice Address - Fax:607-722-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
NY0301308N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309664Medicaid
NY335228Medicare Oscar/Certification