Healthcare Provider Details

I. General information

NPI: 1689222481
Provider Name (Legal Business Name): BRIDGEWATER NURSING HOME CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N MAIN AVE
BRIDGEWATER SD
57319-2004
US

IV. Provider business mailing address

901 N MAIN AVE
BRIDGEWATER SD
57319-2004
US

V. Phone/Fax

Practice location:
  • Phone: 605-729-2525
  • Fax:
Mailing address:
  • Phone: 605-729-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAD STROSCHEIN
Title or Position: DIRECTOR
Credential:
Phone: 605-670-9855