Organization
BRIDGEWAY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STAN PAYNTER (PRESIDENT)
(580) 762-1462
Entity
Organization
Contact information
Practice address
620 W GRAND AVE, PONCA CITY, OK 74601-5123
(580) 762-1462
(580) 765-7299
Mailing address
620 W. GRAND AVE, PONCA CITY, OK 74601
(580) 762-1462
(580) 765-7299
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/13/2007
Last updated
08/22/2020
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