Healthcare Provider Details

I. General information

NPI: 1336701242
Provider Name (Legal Business Name): BRIDGETOWN HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 BRIDGETOWN RD
CINCINNATI OH
45211-4427
US

IV. Provider business mailing address

17 S HIGH ST STE 770
COLUMBUS OH
43215-3450
US

V. Phone/Fax

Practice location:
  • Phone: 513-598-8000
  • Fax: 513-574-7424
Mailing address:
  • Phone: 614-461-1156
  • Fax: 614-461-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2842N
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerLICENSE

VIII. Authorized Official

Name: MR. GEOFFREY EVERETT WEBSTER
Title or Position: COUNSEL
Credential: ESQ.
Phone: 614-461-1156