MEDICARE: BRIDGEWOOD POST ACUTE 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1932856200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWOOD POST ACUTE LLC

Provider Business Mailing Address
First Line	:	5901 LEMON HILL AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-3231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 LEMON HILL AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-3231
Country	:	US
Telephone Number	:	916-383-2741
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROBERT BRANDI
Credential	:
Telephone Number	:	916-677-7416

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/16/2023

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