MEDICARE: BRIDGEPORT SENIOR LIVING - PORT SPRINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1174225254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEPORT SENIOR LIVING - PORT SPRINGS LLC

Provider Business Mailing Address
First Line	:	404 SPRING VALLEY RD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-5845
Country	:	US
Telephone Number	:	407-810-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 SPRING VALLEY RD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-5845
Country	:	US
Telephone Number	:	407-810-1344
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ADAM ANTHONY
Credential	:
Telephone Number	:	407-810-1344

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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