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General NPI Number Information
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NPI Number | 1528249414
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Entity Type | Organization
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Legal Business Name | BRIDGEWOOD HEALTH CARE CENTER, L.L.C.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 11515 TROOST AVENUE
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City | KANSAS CITY
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State | MO
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Zip | 64131-3769
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Country | US
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Telephone | 816-943-0101
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Fax | 816-943-1615
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Provider Business Mailing Address
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Address Line | 1869 CRAIG PARK CT
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4122
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Country | US
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Telephone | 314-543-3800
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Fax | 314-543-3880
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Authorized Official
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Title or Position | FINANCE
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Name | MR. ASHWIN DUNDOO
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Credential |
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Telephone | 314-543-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 038747
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License Number State | MO
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