Healthcare Provider Details

I. General information

NPI: 1457647232
Provider Name (Legal Business Name): BRIDGEVIEW HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BRIDGEVIEW
BEARDSTOWN IL
62618-1069
US

IV. Provider business mailing address

121 E 2ND ST
BEARDSTOWN IL
62618-1263
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-1239
  • Fax:
Mailing address:
  • Phone: 217-323-2980
  • Fax: 217-323-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TONI J TAYLOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 217-323-2980