Organization
BRIDGEWAY PSYCHIATRIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE DILL R.N. (REGIONAL DIRECTOR)
(337) 785-8003
Entity
Organization
Contact information
Practice address
3451 5TH AVE, SUITE A, LAKE CHARLES, LA 70607-2127
(337) 562-0211
(337) 562-0212
Mailing address
3451 5TH AVE, SUITE A, LAKE CHARLES, LA 70607-2127
(337) 562-0211
(337) 562-0212
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1152013
—
LA
01
—
61404
BLUE CROSS BLUE SHIELD
LA
Enumeration date
10/31/2005
Last updated
04/30/2010
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