NPIMap

Organization Active NPI

Watermark 3030 Park LLC

Doing business as The Springs at Watermark 3030 Park

  • Skilled Nursing Facility
  • Bridgeport, CT
National Provider Identifier
1275704462
Registry record updated Jun 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2347 Issued in CT
Legal business name
WATERMARK 3030 PARK LLC
Doing business as
The Springs at Watermark 3030 Park
Practice address
3030 Park Ave
Bridgeport, CT 06604
Phone
(203) 374-4611
Fax
(203) 374-2871
NPI assigned
Mar 17, 2008
Last updated
Jun 2, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2009

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

Authorized official

Name
Mr. David Freshwater
Title
Authorized Agent
Phone
(520) 797-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2347 CT Primary

Addresses

Primary practice location

3030 Park Ave
Bridgeport, CT 06604

Mailing address

3030 Park Ave
Bridgeport, CT 06604
Phone (203) 374-4611

Other names 1

  • The Springs at Watermark 3030 Park Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1275704462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "06604",
            "telephone_number": "203-374-4611",
            "fax_number": "203-374-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "06604",
            "telephone_number": "203-374-4611",
            "fax_number": "203-374-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMARK 3030 PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "FRESHWATER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "520-797-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Springs at Watermark 3030 Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.