Healthcare Provider Details

I. General information

NPI: 1821086091
Provider Name (Legal Business Name): BRIDGEVIEW CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S RIDGEWOOD AVE
ORMOND BEACH FL
32174-7028
US

IV. Provider business mailing address

350 S RIDGEWOOD AVE
ORMOND BEACH FL
32174-7028
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-4545
  • Fax: 386-677-3445
Mailing address:
  • Phone: 386-677-4545
  • Fax: 386-677-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10590961
License Number StateFL

VIII. Authorized Official

Name: MRS. JENNIFER ALISE ZIOLKOWSKI
Title or Position: VP FINANCE
Credential: MBA
Phone: 813-558-6629