Heritage of Bridgeport, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

544002 Issued in NE

Legal business name

HERITAGE OF BRIDGEPORT, INC

Doing business as

Heritage of Bridgeport

Practice address

505 O St
Bridgeport, NE 69336-4045

Phone

(308) 262-0725

Fax

(308) 262-0470

NPI assigned

Aug 25, 2006

Last updated

Jun 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jack Dean Vetter

Title

President

Phone

(402) 895-3932

Specialties & licenses 1

Addresses

Other names 1

• Heritage of Bridgeport Doing business as

Locations

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1891803490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 O STREET",
            "city": "BRIDGEPORT",
            "state": "NE",
            "postal_code": "693364045",
            "telephone_number": "308-262-0725",
            "fax_number": "308-262-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 O ST",
            "city": "BRIDGEPORT",
            "state": "NE",
            "postal_code": "693364045",
            "telephone_number": "308-262-0725",
            "fax_number": "308-262-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE OF BRIDGEPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "VETTER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-895-3932",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "544002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage of Bridgeport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diane E. Gilles, M.D.
• Courtney Gregory
• Denyse M Grimes-Woolbright
• Douglas L. Hadden, PA-C
• Faye Ilene Hart-Maddux
• Benjamin Robert Iske
• J & J Nein LLC (Nein Pharmacy LTC)
• J & J Nein LLC (Nein Pharmacy)
• Sam F. Jacoby, D.D.S.
• Chelsey Marie Kraupie, PT, DPT

• Skilled Nursing Facility in Bridgeport, NE
• Providers in Bridgeport, NE by specialty
• Skilled Nursing Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.