Healthcare Provider Details

I. General information

NPI: 1063735157
Provider Name (Legal Business Name): BRIDGEWOOD NON PROFIT HOUSING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S 26TH ST
ESCANABA MI
49829-1100
US

IV. Provider business mailing address

PO BOX 606
ESCANABA MI
49829-0606
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-4701
  • Fax: 906-786-5853
Mailing address:
  • Phone: 906-786-4701
  • Fax: 906-786-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberAL210006946
License Number StateMI

VIII. Authorized Official

Name: MR. JONATHAN MEAD
Title or Position: CEO
Credential:
Phone: 906-786-4701