Provider Demographics
NPI:1568402295
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:LAKE RIDGE SOLANA ALZHEIMER'S CARE 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:505-821-3355
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 1:817 E PLUM ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1870
Practice Address - Country:US
Practice Address - Phone:509-765-7835
Practice Address - Fax:509-765-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1152311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA583OtherMSC/PREMERA BLUE CROSS
WA4114435Medicaid
WA=========OtherBC/BS FEDERAL EMP PROGRAM
WA=========OtherAETNA HEALTHCARE
WA=========OtherREGENCE BLUE SHIELD
WA=========OtherZENITH ADMINISTRATORS
WA=========OtherNW ADMINISTRATORS INC
WA=========OtherSTERLING LIFE INS CO
WA=========OtherUNIFORM MEDICAL
WA583OtherMSC/PREMERA BLUE CROSS
WA=========OtherBC/BS OF WA & AK
WA=========OtherG.E. FINANCIAL ASSURANCE
WA=========OtherSTATE FARM HEALTH INS
WA=========OtherILWU-PMA WELFARE PLAN
WA4114435Medicaid
WA=========OtherUNITED AMERICAN INSURANCE
WA=========OtherUNITED HEALTHCARE
WA=========OtherMUTUAL OF OMAHA
WA=========OtherFEDERAL HOME LIFE INS
WA=========OtherG.E. FINANCIAL ASSURANCE