Organization
BRIDGEWAY RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENINEZ MOSS (PROGRAM DIRECTOR)
(804) 301-2984
Entity
Organization
Contact information
Practice address
5118 BRIDGESIDE DR, NORTH CHESTERFIELD, VA 23234-2860
(804) 301-2984
(804) 279-0736
Mailing address
5118 BRIDGESIDE DR, NORTH CHESTERFIELD, VA 23234-2860
(804) 301-2984
(804) 279-0736
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
1366
VA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1366
VA
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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