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General NPI Number Information
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NPI Number | 1134408289
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1465 ROUTE 31 S
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City | ANNANDALE
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State | NJ
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Zip | 08801-3129
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Country | US
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Telephone | 908-894-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 373 CLERMONT TER
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City | UNION
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State | NJ
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Zip | 07083-8073
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Country | US
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Telephone | 908-355-7886
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Fax | 908-248-9376
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. KENYA THOMAS
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Credential |
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Telephone | 908-418-2379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 204010248
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License Number State | NJ
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