Provider Demographics
NPI:1366446981
Name:BRIDGEPORT HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:BRIDGEPORT HEALTH CARE CENTER, INC.
Other - Org Name:BRIDGEPORT HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-384-6400
Mailing Address - Street 1:600 BOND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2205
Mailing Address - Country:US
Mailing Address - Phone:203-384-6400
Mailing Address - Fax:
Practice Address - Street 1:600 BOND ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2205
Practice Address - Country:US
Practice Address - Phone:203-384-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2061C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075370Medicare ID - Type Unspecified