Basic Information
| Provider Information | |||||||||
| NPI: | 1669895835 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIDGMAN CARE OPERATING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WEST WOODS OF BRIDGMAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | 2532 W. CADILLAC DR | ||||||||
| City: | FARWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486220579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895883547 | ||||||||
| FaxNumber: | 8888497119 | ||||||||
| Practice Location | |||||||||
| Address1: | 9935 RED ARROW HWY | ||||||||
| Address2: | |||||||||
| City: | BRIDGMAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491069002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694653017 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 01/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | DOYLE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9895883547 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.