Basic Information
| Provider Information | |||||||||
| NPI: | 1457379018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIDGEWATER CENTER FOR REHABILITATION & NURSING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HILLCREST CENTER DRIVE | ||||||||
| Address2: | SUITE #325 | ||||||||
| City: | SPRING VALLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109773740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453718100 | ||||||||
| FaxNumber: | 8453710010 | ||||||||
| Practice Location | |||||||||
| Address1: | 159-163 FRONT STREET | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139053103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077227225 | ||||||||
| FaxNumber: | 6077220061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 11/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | AUGENSTEIN | ||||||||
| AuthorizedOfficialFirstName: | JACK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8453718100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0301308N | NY | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00309664 | 05 | NY | MEDICAID |