Provider Demographics
NPI:1285685362
Name:SUNBRIDGE HEALTHCARE LLC
Entity type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:500 JOHN ALDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-3000
Mailing Address - Country:US
Mailing Address - Phone:256-383-4541
Mailing Address - Fax:256-383-2966
Practice Address - Street 1:500 JOHN ALDRIDGE DR
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-3000
Practice Address - Country:US
Practice Address - Phone:256-383-4541
Practice Address - Fax:256-383-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16644314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010-676OtherBC/BS OF AL & BC/BS OF TN
AL71-00083OtherUNITED HEALTHCARE OF ALA
AL4757720SMedicaid
392722OtherHIGHMARK BLUE SHIELD
AL71-00083OtherUNITED HEALTHCARE OF ALA
AL71-00083OtherUNITED HEALTHCARE OF ALA