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General NPI Number Information
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NPI Number | 1376354092
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY 360 LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 3111 LOS FELIZ BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90039-1519
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Country | US
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Telephone | 347-791-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 305 LEGION ST STE 200
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City | BROOKLYN
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State | NY
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Zip | 11212-4036
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Country | US
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Telephone | 347-791-5595
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAYMA N GARRAWAY-AMADI
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Credential |
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Telephone | 347-791-5595
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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