Healthcare Provider Details

I. General information

NPI: 1497099147
Provider Name (Legal Business Name): BRIDGEWOOD NURSING AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BYRD AVE
NEENAH WI
54956-4015
US

IV. Provider business mailing address

6340 S 3000 E SUITE 330
SALT LAKE CITY UT
84121-3540
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-2714
  • Fax:
Mailing address:
  • Phone: 801-601-1450
  • Fax: 801-996-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE DYER
Title or Position: HUMAN RESOURCES
Credential:
Phone: 801-601-1450