Healthcare Provider Details

I. General information

NPI: 1063365237
Provider Name (Legal Business Name): BRIDGEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 CLERMONT TER
UNION NJ
07083-8073
US

IV. Provider business mailing address

373 CLERMONT TER
UNION NJ
07083-8073
US

V. Phone/Fax

Practice location:
  • Phone: 908-355-7886
  • Fax: 908-248-9376
Mailing address:
  • Phone: 908-355-7886
  • Fax: 908-248-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: FRED OLMSTED
Title or Position: DIRECTOR OF BILLING
Credential: MS, CADC
Phone: 848-304-2436