Organization
BRIDGEWATER AVONDALE OPERATIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. INGE G DURAN (VP OF FINANCE)
(602) 544-3195
Entity
Organization
Contact information
Practice address
295 E VAN BUREN STREET, AVONDALE, AZ 85323
(602) 603-8200
(602) 533-7574
Mailing address
14650 N 78TH WAY, BLDG B, SCOTTSDALE, AZ 85260
(602) 544-3195
(602) 533-7574
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL10996C
DEPT OF HEALTH SERVICES
AZ
Enumeration date
01/24/2019
Last updated
01/24/2019
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