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General NPI Number Information
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NPI Number | 1730771973
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY HOME CARE, LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 315 E 5TH ST STE 202
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City | WATERLOO
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State | IA
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Zip | 50703-4757
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Country | US
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Telephone | 860-266-0195
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 20TH AVE
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City | EAST MOLINE
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State | IL
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Zip | 61244-2220
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Country | US
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Telephone | 860-266-0195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NOOR AFREDE
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Credential |
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Telephone | 860-266-0195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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