Healthcare Provider Details

I. General information

NPI: 1396112173
Provider Name (Legal Business Name): BRIDGEWOOD VILLAGE ON SC TRS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20305 HOLZWARTH RD
SPRING TX
77388-5582
US

IV. Provider business mailing address

6363 WOODWAY DR #410
HOUSTON TX
77057-1735
US

V. Phone/Fax

Practice location:
  • Phone: 281-257-2299
  • Fax: 281-996-1141
Mailing address:
  • Phone: 281-996-0101
  • Fax: 281-996-1141

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