Healthcare Provider Details

I. General information

NPI: 1528022886
Provider Name (Legal Business Name): BRIDGEPORT CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W CATES ST
BRIDGEPORT TX
76426-2709
US

IV. Provider business mailing address

1515 HERITAGE DR SUITE 212
MCKINNEY TX
75069-3256
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-5181
  • Fax: 940-683-5183
Mailing address:
  • Phone: 214-256-3787
  • Fax: 214-256-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number4054
License Number StateTX

VIII. Authorized Official

Name: HEIDI W BRASWELL
Title or Position: COO
Credential:
Phone: 214-256-3787