Healthcare Provider Details

I. General information

NPI: 1184469082
Provider Name (Legal Business Name): BRIDGEWAY OF BENSENVILLE INDEPENDENT LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E WASHINGTON ST
BENSENVILLE IL
60106-3515
US

IV. Provider business mailing address

303 E WASHINGTON ST
BENSENVILLE IL
60106-3515
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0605
  • Fax: 630-766-0752
Mailing address:
  • Phone: 630-766-0605
  • Fax: 630-766-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNA SARAH SALAZAR DUJUA
Title or Position: DIRECTOR OF A/R
Credential:
Phone: 630-217-1014