=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336701242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGETOWN HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2019
-----------------------------------------------------
Last Update Date | 07/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4307 BRIDGETOWN RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45211-4427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-598-8000
-----------------------------------------------------
Fax | 513-574-7424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 S HIGH ST STE 770
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-461-1156
-----------------------------------------------------
Fax | 614-461-7168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSEL
-----------------------------------------------------
Name | MR. GEOFFREY EVERETT WEBSTER
-----------------------------------------------------
Credential | ESQ.
-----------------------------------------------------
Telephone | 614-461-1156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 2842N
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | OH
-----------------------------------------------------
Identifier Issuer | LICENSE
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 2842N
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State | OH
-----------------------------------------------------
Identifier Issuer | LICENSE
-----------------------------------------------------