Provider Demographics
NPI:1316319270
Name:BRIDGE-BROOKSIDE, LLC
Entity type:Organization
Organization Name:BRIDGE-BROOKSIDE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M OF GP OF MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-457-7892
Mailing Address - Street 1:1850 MT DIABLO BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4439
Mailing Address - Country:US
Mailing Address - Phone:925-457-7892
Mailing Address - Fax:
Practice Address - Street 1:93 MANALAPAN AVE
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1626
Practice Address - Country:US
Practice Address - Phone:732-303-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility