NPIMap

Organization Active NPI

Bridgeway, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Galesburg, IL
National Provider Identifier
1407024284
Registry record updated Apr 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BRIDGEWAY, INC
Practice address
639 Hawthorne CT
Galesburg, IL 61401-1200
Phone
(309) 344-2323
NPI assigned
Feb 14, 2008
Last updated
Apr 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Nelson
Title
Ceo
Phone
(309) 344-2323

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Mental Illness Intermediate Care Facility 310500000X NU

Addresses

Primary practice location

639 Hawthorne CT
Galesburg, IL 61401-1200

Mailing address

2323 Windish Dr
Galesburg, IL 61401-9780

National Provider Directory

National Provider Directory
Tax ID family
Julio R Lozano MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

639 Hawthorne Ct
Galesburg, IL 61401
Phone (309) 344-2323

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1407024284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 WINDISH DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614019780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 HAWTHORNE CT",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011200",
            "telephone_number": "309-344-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWAY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-344-2323"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.