1821086091 NPI number — BRIDGEVIEW CENTER, LLC

Table of content: (NPI 1821086091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821086091 NPI number — BRIDGEVIEW CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGEVIEW CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821086091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 S RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-7028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-677-4545
Provider Business Mailing Address Fax Number:
386-677-3445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 S RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-7028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-677-4545
Provider Business Practice Location Address Fax Number:
386-677-3445
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZIOLKOWSKI
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ALISE
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
813-558-6629

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF10590961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N98 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 026037100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007930518 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: C105402 . This is a "UNITED AMERICAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 026037100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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