Bridgeway, Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Galesburg, IL
NPI 1154545879 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1154545879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- BRIDGEWAY, INC
- Practice address
- 1089 Hawkinson Ave
Galesburg, IL 61401-6900 - Phone
- (309) 343-2639
- Fax
- (309) 341-4770
- NPI assigned
- Apr 12, 2007
- Organization subpart
- No
Authorized official
- Name
- William Nelson
- Title
- Ceo
- Phone
- (309) 344-2323
Other NPIs on the same Medicare enrollment 15
Practitioners 10
-
Debra Mollie Davis, RN BSN
-
Valerie Sze-Lynn Leong, M.D.
-
Dorothy J Loop, RN
-
Kathleen E Markey, R.N.
-
Pamela Sue Marston, LPN CADC DUI QHEC
-
Rachelle D McCoy, R N C
-
Jennifer Lynn Piester, LCSW
-
Kevin Franklin Satisky, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050126000609 | IL | Part B Supplier - Clinic/Group Practice | 4284627530 |
Receives reassigned benefits from 9 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Macomb, IL; Moline, IL; Monmouth, IL; Normal, IL; North Pekin, IL; Pekin, IL; Kewanee, IL; Loves Park, IL… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | IL | Yes | |
| Mental Illness Intermediate Care Facility | 310500000X | -031 | IL |
Addresses
Primary practice location
1089 Hawkinson Ave
Galesburg, IL 61401-6900
Mailing address
1089 Hawkinson Ave
Galesburg, IL 61401-6900
Phone (309) 343-2639
Other providers in Galesburg, IL
- Bridgeway Inc
- Bridgeway Inc
- Bridgeway Inc.
- Bridgeway Inc.
- Bridgeway Incorporated
- Bridgeway, Inc
- Bridgeway, Inc
- Bridgeway, Inc
- Bridgeway, Inc
- Bridgeway, Inc
All providers in Galesburg, IL · Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.