Provider Demographics
NPI:1528022886
Name:BRIDGEPORT CARE CENTER, INC
Entity Type:Organization
Organization Name:BRIDGEPORT CARE CENTER, INC
Other - Org Name:BRIDGEPORT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-256-3787
Mailing Address - Street 1:1515 HERITAGE DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3256
Mailing Address - Country:US
Mailing Address - Phone:214-256-3787
Mailing Address - Fax:214-256-3789
Practice Address - Street 1:102 W CATES ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2709
Practice Address - Country:US
Practice Address - Phone:940-683-5181
Practice Address - Fax:940-683-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4054313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676126Medicare ID - Type UnspecifiedMEDICARE