13D2013844 CLIA NUMBER - BRIDGEWAY HEALTH SERVICES

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Laboratory Demographics

CLIA Number: 13D2013844

Facility Name: BRIDGEWAY HEALTH SERVICES

Facility Address:
1032 S BRIDGEWAY PLACE #110
EAGLE, ID
ZIP 83616
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Facility Phone Number: 208 475-0800

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1265703953

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2013844
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	BRIDGEWAY HEALTH SERVICES
Street	1032 S BRIDGEWAY PLACE #110
City	EAGLE
State	ID
ZIP	83616
Phone	208 475-0800
CertificateType	4
CertificateEffectiveDate	9/24/2022
CertificateExpirationDate	9/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024