Provider Demographics
NPI:1235669045
Name:SB HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SB HEALTHCARE, LLC
Other - Org Name:BRIDGEWAY PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-932-6302
Mailing Address - Street 1:1395 SOUTH MARIETTA PKWY
Mailing Address - Street 2:BLDG 400 SUITE 102
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:678-932-6302
Mailing Address - Fax:678-402-5246
Practice Address - Street 1:2000 RIVERSIDE PKWY STE 107
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5926
Practice Address - Country:US
Practice Address - Phone:678-878-3215
Practice Address - Fax:678-878-3341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SB HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-0428-H207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty