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General NPI Number Information
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NPI Number | 1124460969
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Entity Type | Organization
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Legal Business Name | BRIDGEPORT SENIOR LIVING - PORT ISLE
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 13506 SUMMERPORT VILLAGE PKWY 129
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City | WINDERMERE
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State | FL
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Zip | 34786-7366
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Country | US
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Telephone | 407-203-0868
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Fax |
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Provider Business Mailing Address
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Address Line | 13506 SUMMERPORT VILLAGE PKWY 129
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City | WINDERMERE
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State | FL
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Zip | 34786-7366
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | KEVIN GALBASINI
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Credential |
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Telephone | 407-760-3649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12372
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License Number State | FL
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