Organization
BRIDGEWAY RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL REGINA SPENCER (DIRECTOR)
(434) 315-3399
Entity
Organization
Contact information
Practice address
102 MINNIE LANE DRIVE, PHENIX, VA 23959
(434) 315-3399
Mailing address
3648 PATSY ANN DR, RICHMOND, VA 23234-2952
(434) 315-3399
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
04/26/2011
Last updated
04/26/2011
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