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General NPI Number Information
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NPI Number | 1225577505
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Entity Type | Organization
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Legal Business Name | BRIDGEWATER PARK LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 9280 SW 81ST CT
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City | OCALA
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State | FL
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Zip | 34481
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Country | US
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Telephone | 352-509-5201
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Fax | 352-861-4255
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Provider Business Mailing Address
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Address Line | 1800 N WABASH RD
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City | MARION
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State | IN
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Zip | 46952-1300
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Country | US
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Telephone | 765-664-5400
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CULLEN S GIBSON
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Credential |
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Telephone | 765-664-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | FL
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