Basic Information
| Provider Information | |||||||||
| NPI: | 1093371585 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARECORE AT BRIDGETOWN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4307 BRIDGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452114427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135988000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4307 BRIDGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452114427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135988000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | LAGHAIE | ||||||||
| AuthorizedOfficialFirstName: | EITAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF HR AND BUSINESS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 3106947405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.