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NPI Code Detail

MEDICARE: BRIDGES NURSING AND REHABILITATION LLC

MEDICARE: BRIDGES NURSING AND REHABILITATION 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578790572
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGES NURSING AND REHABILITATION LLC
Provider Business Mailing Address
First Line : 1240 MARBELLA PLAZA DR.
Second Line :
City : TAMPA
State : FL
Zip : 33619-7906
Country : US
Telephone Number : 813-341-2700
Fax Number : 813-676-0126
Provider Business Practice Location Address
First Line : 1203 E 22ND AVE
Second Line :
City : TAMPA
State : FL
Zip : 33605-1719
Country : US
Telephone Number : 813-229-6901
Fax Number : 813-676-0126
Authorized Official
Title or Position : PRESIDENT
Name : MR. ROBERT DANIEL VAUGHAN
Credential :
Telephone Number : 813-341-2700
Provider Enumeration Date : 06/17/2009
Last Update Date : 12/03/2010

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