Provider Demographics
NPI:1588611297
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:WILLOWS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHIES
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 1:320 N CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2326
Practice Address - Country:US
Practice Address - Phone:530-934-2834
Practice Address - Fax:530-934-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000054314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70066GMedicaid
CALTC55151GMedicaid
CA=========OtherNATIONWIDE HEALTH PLAN
CALTC55151GMedicaid
CA=========OtherAARP
CA=========OtherMOTION PICTURE INDUSTRY
CA=========OtherHEALTH NET
CA=========OtherPBP HEALTH PLAN
CALTC70066GMedicaid
CA=========OtherBLUE CROSS FERDERAL
CA=========OtherKAISER UNION CITY LANDING
CA=========OtherPIONEERLIFE
CA=========OtherUNITED AMERICAN INS. CO.
CA=========OtherUNITED HEALTHCARE
CA=========OtherBLUE SHIELD OF CA
CA=========OtherCONSECO HEALTH INS
CA=========OtherGE LIFE AND ANNUITY CO.
CA=========OtherBANKERS LIFE AND CASUALTY
CA=========OtherCONSECO HEALTH INS