Healthcare Provider Details

I. General information

NPI: 1679846471
Provider Name (Legal Business Name): BRIDGEWOOD HUNTSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E PARKWOOD AVE STE 100
FRIENDSWOOD TX
77546-5152
US

IV. Provider business mailing address

2805 LAKE RD
HUNTSVILLE TX
77340-5600
US

V. Phone/Fax

Practice location:
  • Phone: 281-996-0101
  • Fax: 281-996-1141
Mailing address:
  • Phone: 936-295-0600
  • Fax: 936-295-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES D. GRAY
Title or Position: MANAGER
Credential:
Phone: 281-996-0101