Basic Information
| Provider Information | |||||||||
| NPI: | 1265553564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIDGEWAY CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508337500 | ||||||||
| FaxNumber: | 8508337528 | ||||||||
| Practice Location | |||||||||
| Address1: | 299 W RAILROAD AVE | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325364053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506897810 | ||||||||
| FaxNumber: | 8506897474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | BARLOW | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8508333975 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.