MEDICARE: BRIDGEWAY COMMUNITY SERVICES ,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		DC
2	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1467788612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWAY COMMUNITY SERVICES ,INC

Provider Business Mailing Address
First Line	:	7600 GEORGIA AVE NW STE 301
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1616
Country	:	US
Telephone Number	:	301-585-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 GEORGIA AVE NW STE 301
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1616
Country	:	US
Telephone Number	:	301-585-1009
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISAIAH A TEASLEY
Credential	:
Telephone Number	:	301-585-1099

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	01/23/2020

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