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General NPI Number Information
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NPI Number | 1043235716
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY ESTATES
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 12TH ST. NE
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City | LITTLE FALLS
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State | MN
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Zip | 56345
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Country | US
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Telephone | 320-632-2089
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Fax | 320-632-2097
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Provider Business Mailing Address
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Address Line | 103 12TH ST. NE
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City | LITTLE FALLS
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State | MN
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Zip | 56345
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Country | US
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Telephone | 320-632-2089
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Fax | 320-632-2097
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Authorized Official
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Title or Position | BOARD OF DIRECTORS, PRESIDENT
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Name | MR. MERLIN ARTHUR KOESTER
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Credential |
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Telephone | 320-632-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 330186
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License Number State | MN
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