Provider Demographics
NPI:1730771973
Name:BRIDGEWAY HOME CARE, LLC
Entity type:Organization
Organization Name:BRIDGEWAY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AFREDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-266-0195
Mailing Address - Street 1:1030 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-2220
Mailing Address - Country:US
Mailing Address - Phone:860-266-0195
Mailing Address - Fax:
Practice Address - Street 1:315 E 5TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4757
Practice Address - Country:US
Practice Address - Phone:860-266-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care