MEDICARE: BRIDGEWAY ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1144182726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWAY ABA LLC

Provider Business Mailing Address
First Line	:	3296 WESTERVILLE RD # 1039
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3790
Country	:	US
Telephone Number	:	720-999-2993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3296 WESTERVILLE RD # 1039
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-3790
Country	:	US
Telephone Number	:	720-999-2993
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KHADAR MOHAMED
Credential	:
Telephone Number	:	720-999-2993

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “BRIDGEWAY ABA LLC ” Practice Location

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