Provider Demographics
NPI:1073560827
Name:SUNBRIDGE CLIPPER HOME OF ROCHESTER, LLC.
Entity Type:Organization
Organization Name:SUNBRIDGE CLIPPER HOME OF ROCHESTER, LLC.
Other - Org Name:COLONIAL HILL OF ROCHESTER CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:101 SUN AVE NE
Mailing Address - Street 2:COMPLIANCE DEPARTMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4373
Mailing Address - Country:US
Mailing Address - Phone:505-468-5604
Mailing Address - Fax:505-468-4681
Practice Address - Street 1:62 ROCHESTER HILL ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3216
Practice Address - Country:US
Practice Address - Phone:603-335-3955
Practice Address - Fax:603-335-7109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02458313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001712Medicaid
=========OtherBANKER'S LIFE & CASUALTY
=========OtherCONSECO
=========OtherSEACOAST HOSPICE
=========OtherAARP
=========OtherME BC BS
=========OtherFEDERAL BC
=========OtherMONUMENTAL LIFE
=========OtherWAUSAU
=========OtherAFLAC
MA=========OtherMA BC BS
=========OtherAETNA
NH30001712Medicaid
=========OtherANTHEM BLUE CROSS
=========OtherWAUSAU