Provider Demographics
NPI:1083957039
Name:BRIDGEPORT SENIOR LIVING LLC
Entity Type:Organization
Organization Name:BRIDGEPORT SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALBASINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-760-3649
Mailing Address - Street 1:13546 DARCHANCE RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6305
Mailing Address - Country:US
Mailing Address - Phone:407-760-3648
Mailing Address - Fax:877-784-0844
Practice Address - Street 1:8341 LAKE CROWELL CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5931
Practice Address - Country:US
Practice Address - Phone:407-730-2582
Practice Address - Fax:407-730-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL2280310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility