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BRIDGEWAY RESIDENTIAL CARE FACILITY LLC NPI 1497344147


NPI Information

NPI: 1497344147
Provider Name: BRIDGEWAY RESIDENTIAL CARE FACILITY, LLC
Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization

CLIA Number: 26D1090329

Address:
828 JEFFERSON ST
FULTON, MO
ZIP 65251
Phone: (573) 642-7770
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BRIDGEWAY RESIDENTIAL CARE FACILITY, LLC is a residential treatment facility, intellectual and/or developmental disabilities in Fulton, MO. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. BRIDGEWAY RESIDENTIAL CARE FACILITY, LLC NPI is 1497344147. The provider is registered as an organization entity type.

The provider's business location address is:

828 JEFFERSON ST
FULTON, MO
ZIP 65251-877
Phone: (573) 642-7770
Fax: (573) 642-7790

The provider's authorized official is Sue Rudroff .
The authorized official title is Rn/owner and has the following contact phone number (573) 489-0246.

The CLIA number assigned to this NPI record is 26D1090329 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/15/2021 and was last updated on 5/26/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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