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Organization
BRIDGEPORT CENTER LLC
Active
Organization
BRIDGEPORT CENTER LLC
Active
Other names
Stonerise Bridgeport
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE A PACK (MANAGER)
(304) 343-1950
Entity
Organization
Contact information
Practice address
41 CRESTVIEW TER, BRIDGEPORT, WV 26330-1010
(304) 842-7101
(304) 842-7104
Mailing address
700 CHAPPELL RD, CHARLESTON, WV 25304-2704
(304) 343-1950
(304) 343-1947
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
NULL
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Enumeration date
12/08/2016
Last updated
05/18/2022
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