Provider Demographics
NPI:1346291176
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:CYPRESS COVE 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 1:200 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3102
Mailing Address - Country:US
Mailing Address - Phone:256-381-4330
Mailing Address - Fax:256-381-4331
Practice Address - Street 1:200 ALABAMA AVE.
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3102
Practice Address - Country:US
Practice Address - Phone:256-381-4330
Practice Address - Fax:256-381-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4757700SMedicaid
AL010-667OtherBCBS OFAL (GENERAL MOTORS
TN3085041OtherBCBS OF TENN
TX71-00119OtherUNITED HEALTHCARE
KS83546575OtherCONTINENTAL GENERAL INS.
GA0931006233OtherAARP
AL14859OtherFIRST COMMUNIT HEALTH PLA
KS83546575OtherCONTINENTAL GENERAL INS.
AL14859OtherFIRST COMMUNIT HEALTH PLA
TN3085041OtherBCBS OF TENN
PA=========-01OtherBCBS ALN