| NPI | 1144811290 |
|---|---|
| Doing Business As | COMMUNITY CARE OF BRIDGEPORT |
| Entity Type | Organization |
| Authorized Contact | DORA L POTASNIK Credentialing Coordinator 304-317-7275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-17 |