NPIMap

Organization Active NPI

Bridgeport Senior Living, LLC

  • Nursing Facility/Intermediate Care Facility
  • Bridgeport, WV
National Provider Identifier
1255427415
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
7 Issued in WV
Legal business name
BRIDGEPORT SENIOR LIVING, LLC
Practice address
RR 4 Box 17
Bridgeport, WV 26330-9509
Phone
(304) 842-4135
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jon M. Harder
Title
MGR. Bridgeport Senior Living, LLC
Phone
(503) 375-9016

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 7 WV Primary

Addresses

Primary practice location

RR 4 Box 17
Bridgeport, WV 26330-9509

Mailing address

RR 4 Box 17
Bridgeport, WV 26330-9509
Phone (304) 842-4135

Other names 1

  • The Heritage Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bridgeport Senior Living LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255427415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 4 BOX 17",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309509",
            "telephone_number": "304-842-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 4 BOX 17",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309509",
            "telephone_number": "304-842-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARDER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MGR. BRIDGEPORT SENIOR LIVING, LLC",
        "authorized_official_telephone_number": "503-375-9016"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WV",
            "license": "7",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Heritage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.