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General NPI Number Information
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NPI Number | 1740571728
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 102 MINNIE LANE DRIVE
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City | PHENIX
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State | VA
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Zip | 23959
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Country | US
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Telephone | 434-315-3399
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Fax |
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Provider Business Mailing Address
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Address Line | 3648 PATSY ANN DR
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City | RICHMOND
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State | VA
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Zip | 23234-2952
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Country | US
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Telephone | 434-315-3399
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CHERYL REGINA SPENCER
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Credential |
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Telephone | 434-315-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1366
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 1366
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License Number State | VA
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