| Bridgeway Inc | |
|
310 Wylie Dr Suite 464 Normal IL 61761-5504 | |
| (309) 452-2797 | |
| (309) 452-9811 |
| Full Name | Bridgeway Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 310 Wylie Dr, Normal, Illinois |
| Authorized Official Name and Position | William Nelson (CEO) |
| Authorized Official Contact | 3093442323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeway Inc 310 Wylie Dr Suite 464 Normal IL 61761-5504 Ph: (309) 452-2797 | Bridgeway Inc 310 Wylie Dr Suite 464 Normal IL 61761-5504 Ph: (309) 452-2797 |
| NPI Number | 1588948046 |
|---|---|
| Provider Enumeration Date | 10/03/2011 |
| Last Update Date | 08/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588948046 | NPI | - | NPPES |
| AC 217/557-9285 | Other | IL | MEDICARE CERTIFICATION |
| 04016 | Medicaid | IL |
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