Provider Demographics
NPI:1568657021
Name:BRIDGEPORT HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:BRIDGEPORT HOME HEALTH CARE, INC.
Other - Org Name:BRIDGEPORT HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLER-SHIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-612-2721
Mailing Address - Street 1:10661 AIRPORT PULLING RD N
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7335
Mailing Address - Country:US
Mailing Address - Phone:239-262-5002
Mailing Address - Fax:239-514-1699
Practice Address - Street 1:10661 AIRPORT PULLING RD N
Practice Address - Street 2:SUITE 9
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7335
Practice Address - Country:US
Practice Address - Phone:239-262-5002
Practice Address - Fax:239-514-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health