Healthcare Provider Details

I. General information

NPI: 1558706705
Provider Name (Legal Business Name): BRIDGEWOOD KATY II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 KATY FLEWELLEN RD
KATY TX
77494-6349
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 281-392-2800
  • Fax:
Mailing address:
  • Phone: 281-996-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICIA E COOK
Title or Position: PARALEGAL
Credential:
Phone: 281-996-0101