Healthcare Provider Details

I. General information

NPI: 1154896694
Provider Name (Legal Business Name): BRIDGEPARK OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 LIBERTY HEIGHTS AVE
BALTIMORE MD
21207-7545
US

IV. Provider business mailing address

14C 53RD ST STE 220
BROOKLYN NY
11232-2644
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-5306
  • Fax:
Mailing address:
  • Phone: 718-567-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SAM STERN
Title or Position: CFO
Credential:
Phone: 718-567-0400