Provider Demographics
NPI:1508082728
Name:SUNBRIDGE HARBOR VIEW REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HARBOR VIEW REHABILITATION CENTER LLC
Other - Org Name:SUNBRIDGE HARBOR VIEW COMMUNITY SERVICES 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 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:505-468-4742
Mailing Address - Fax:505-468-8742
Practice Address - Street 1:850 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4628
Practice Address - Country:US
Practice Address - Phone:562-981-9392
Practice Address - Fax:562-981-2622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENCY HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
CA940000148251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7270Medicaid