Healthcare Provider Details

I. General information

NPI: 1326493834
Provider Name (Legal Business Name): BRIDEWAY HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 E 29TH ST
MARSHFIELD WI
54449-5627
US

IV. Provider business mailing address

1427 E 29TH ST
MARSHFIELD WI
54449-5627
US

V. Phone/Fax

Practice location:
  • Phone: 715-897-5911
  • Fax: 715-389-2282
Mailing address:
  • Phone: 715-897-5911
  • Fax: 715-389-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SEIDL
Title or Position: OWNER
Credential:
Phone: 715-897-5911