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Organization
BRIDGEWAY BEHAVIORAL HEALTH LLC
Active
Organization
BRIDGEWAY BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRMA FUNES (AUTHORIZED OFFICIAL)
(847) 749-1104
Entity
Organization
Contact information
Practice address
1440 RENAISSANCE DR STE 125, PARK RIDGE, IL 60068-1414
(847) 722-4901
Mailing address
5341 CAROL ST, SKOKIE, IL 60077-2002
(847) 722-4901
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578817003
—
IL
Enumeration date
12/04/2021
Last updated
03/08/2022
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