PMG OPCO-BRIDGEPORT LLC (NPI# 1114469046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114469046 |
| Entity Type | Organization |
| Organization Name | PMG OPCO-BRIDGEPORT LLC |
| Other Organization Name | THE RESIDENCES AT SENIOR CARE |
| Practice Address |
2106 15th St Bridgeport TX 76426-2073 |
| Practice Telephone | 9406836307 |
| Practice Fax Number | 9406835307 |
| Mailing Telephone | 9406836307 |
| Mailing Fax Number | 9406835307 |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |
| Authorized Official Name | DOUGLAS B BOULWARE (MANAGING MEMBER) |
| Authorized Official Telephone | 3186589977 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | TX | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| THE RESIDENCES AT SENIOR CARE | Doing Business As Name - Organization |
| Street Address |
2106 15TH ST |
| City | BRIDGEPORT |
| State | TX |
| Zip Code | 76426-2073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659508208 | Scc Partners, Inc. | Assisted Living Facility | 2106 15th St, Bridgeport, TX 76426-2073 | 2009-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790169613 | Victor Esmeraldo | Dentist | 1808 Chico Hwy, Bridgeport, TX 76426 | 2015-07-10 |
| 1376941013 | K&h Dental Pa | Clinic/Center | 1808 Chico Highway, Bridgeport, TX 76426 | 2014-12-11 |
| 1710252572 | Jonathon Stanley Scarborough | Nurse Anesthetist, Certified Registered | 1509 Dr. Hospital Drive, Bridgeport, TX 76426 | 2012-03-13 |
| 1124153010 | Christopher Aaron Hicks | Physical Therapist | 707 Woodrow Wilson Ray Cir, Bridgeport, TX 76426 | 2007-02-22 |
| 1578636411 | 34hha, Inc | Home Health | 401 Center Ct., Bridgeport, TX 76426 | 2006-11-16 |
| 1295777902 | West 380 Nursing Center | Assisted Living Facility | 2108 15th St, Bridgeport, TX 76426 | 2006-06-10 |
| 1780810234 | Scc Partners Inc | Skilled Nursing Facility | 2108 15th St, Bridgeport, TX 76426 | 2009-06-10 |
| 1477175628 | Noemi Araceli Meza | Non-emergency Medical Transport (VAN) | 1006 Newby Ave, Bridgeport, TX 76426-2030 | 2020-05-11 |
| 1992013692 | Bridgeport Isd | Local Education Agency (LEA) | 2107 15th St, Bridgeport, TX 76426-2052 | 2010-09-16 |
| 1952853194 | City of Ennis | Skilled Nursing Facility | 2108 15th St, Bridgeport, TX 76426-2055 | 2016-11-03 |
| Find all providers in zip 76426 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1659508208 | Scc Partners, Inc. | Assisted Living Facility | 2106 15th St, Bridgeport, TX 76426-2073 | 2009-06-22 |
| 1730301870 | Maplewood | Assisted Living Facility | 1000 South Maplewood Drive, Bridgeport, WV 26330 | 2007-05-02 |
| 1295777902 | West 380 Nursing Center | Assisted Living Facility | 2108 15th St, Bridgeport, TX 76426 | 2006-06-10 |
| 1043429301 | Bridgeport Senior Living, LLC | Assisted Living Facility | Rr 4 Box 17, Bridgeport, WV 26330-9509 | 2007-05-22 |
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|---|---|---|---|---|
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| 1548860067 | Zenith Care Inc | Assisted Living Facility | 1513 Baffin Bay Dr, Plano, TX 75075-2203 | 2020-10-26 |
| 1003415712 | Valarie C Williams | Assisted Living Facility | 2019 Greenwest Dr, Missouri City, TX 77489-4043 | 2020-10-23 |
| 1902404791 | Heritage Retreat Management Group, Inc. | Assisted Living Facility | 7105 Hot Creek Trce, Humble, TX 77346-3098 | 2020-10-13 |
| 1255939104 | Rance Carrington | Assisted Living Facility | 1137 W California St, Seymour, TX 76380-1552 | 2020-10-13 |
| 1083212211 | Neighbors Care, LLC | Assisted Living Facility | 3906 Everett Terrace Ln, Missouri City, TX 77459-1888 | 2020-10-10 |
| 1598362840 | Golden Age Home Care | Assisted Living Facility | 12706 Mutiny Ln, Tomball, TX 77377-8420 | 2020-10-08 |
| 1164038253 | Residential Senior Care (rsc) | Assisted Living Facility | 8040 Honeywood Trial, Port Arthur, TX 77642 | 2020-09-23 |
| 1548874670 | A Compassionate Assisted Living LLC | Assisted Living Facility | 1008 Springbrook Dr, Desoto, TX 75115-3944 | 2020-09-04 |
| 1679187975 | Arc Willowbrook, LLC | Assisted Living Facility | 7450 Willow Chase Blvd, Houston, TX 77070-5867 | 2020-09-03 |
| Find all providers with the same taxonomy | ||||
| City | BRIDGEPORT |
| Zip Code | 76426 |
Please comment or provide details below to improve the information on PMG OPCO-BRIDGEPORT LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.