MEDICARE: BRIDGEWOOD INC.

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	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922545300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWOOD INC.

Provider Business Mailing Address
First Line	:	8011 N POINT BLVD
Second Line	:	SUITE 102
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-727-3592
Fax Number	:

Provider Business Practice Location Address
First Line	:	8011 N POINT BLVD
Second Line	:	SUITE 102
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-727-3592
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KESHA SPAULDING
Credential	:
Telephone Number	:	336-493-2094

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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Directions to “BRIDGEWOOD INC. ” Practice Location

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