Provider Demographics
NPI:1114974649
Name:SUNBRIDGE DUNBAR HEALTH CARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE DUNBAR HEALTH CARE LLC
Other - Org Name:DUNBAR 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:T
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 1:501 CALDWELL LANE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2026
Practice Address - Country:US
Practice Address - Phone:304-744-4761
Practice Address - Fax:304-744-5762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE CARE ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-29
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV82313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000391983OtherBCBS OF COLUMBIA
WV0003913000Medicaid
WV000391983OtherFEDERAL BCBS
KY000391983OtherANTHEM BCBS
VA=========OtherC&O EMPLOYEES
WV=========OtherACCORDIA PEIA
KY=========OtherCARELINK
IL=========OtherBANKERS LIFE
WV0003913000Medicaid
KY000391983OtherANTHEM BCBS
WV000391983OtherFEDERAL BCBS
GA=========OtherAARP PRUDENTIAL
MD=========OtherAPWU
CT=========OtherCIGNA HEALTHCARE
=========OtherBANKERS FIDELITY INSURANC
TX=========OtherBENEFIT PLANNERS
SC000391983OtherBCBS OF COLUMBIA
FL=========OtherAMERICAN GENERAL
FL=========OtherCOMMUNITY CARE NETWORK
TX=========OtherBENEFIT PLANNERS