| Organization Name: | BRIDGEPORT SENIOR LIVING - PORT ISLE LLC |
| NPI Number: | 1124431762 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN GALBASINI (OWNER) |
| Mailing Address: | 13506 Summerport Village Pkwy #129 Windermere |
| State: | FL US |
| Postal Code: | 347867366 |
| Phone Number: | 4077603649 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3747A0650X |
| License Number: | 12372 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Technician |
| Taxonomy Specialization: | Attendant Care Provider |
| Taxonomy Definition: | An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |