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Organization

BRIDGEWAY INC.

Active
Parent organization
BRIDGEWAY INC.
Other names
Love's Park
Organization subpart
Yes

Provider details

NPI number
Legal business name
BRIDGEWAY INC.
Authorized official
WILLIAM NELSON (CEO)
(309) 344-2323
Entity
Organization

Contact information

Practice address
7200 CLINTON RD, LOVES PARK, IL 61111-3806
(815) 962-8333
Mailing address
7200 CLINTON RD, LOVES PARK, IL 61111-3806
(815) 962-8333
(815) 964-3553

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
655360
UPIN
IL
Enumeration date
04/16/2018
Last updated
04/16/2018
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