Provider Demographics
NPI:1942090469
Name:BRIDGEWAY WELLNESS
Entity type:Organization
Organization Name:BRIDGEWAY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP-R
Authorized Official - Phone:804-306-3705
Mailing Address - Street 1:603 EPPES ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2418
Mailing Address - Country:US
Mailing Address - Phone:804-306-3705
Mailing Address - Fax:804-306-3705
Practice Address - Street 1:603 EPPES ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2418
Practice Address - Country:US
Practice Address - Phone:804-306-3705
Practice Address - Fax:804-306-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility