Provider Demographics
NPI:1093371585
Name:CARECORE AT BRIDGETOWN LLC
Entity Type:Organization
Organization Name:CARECORE AT BRIDGETOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF HR AND BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGHAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-694-7405
Mailing Address - Street 1:4307 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4427
Mailing Address - Country:US
Mailing Address - Phone:513-598-8000
Mailing Address - Fax:
Practice Address - Street 1:4307 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4427
Practice Address - Country:US
Practice Address - Phone:513-598-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility