| Bridgeway Inc | |
|
2079 Edgewater Dr Pekin IL 61554 | |
| (309) 382-2006 | |
| (309) 382-2007 |
| Full Name | Bridgeway Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2079 Edgewater Dr, Pekin, 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 2079 Edgewater Dr Pekin IL 61554-7833 Ph: (309) 382-2006 | Bridgeway Inc 2079 Edgewater Dr Pekin IL 61554 Ph: (309) 382-2006 |
| NPI Number | 1346524899 |
|---|---|
| Provider Enumeration Date | 10/03/2011 |
| Last Update Date | 07/25/2022 |
| Certification Date | 07/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346524899 | NPI | - | NPPES |
| AC 217/557-9285 | Other | IL | MEDICARE CERTIFICATION |
| 04016 | Medicaid | IL |
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