Provider Demographics
NPI:1639126493
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:MERIDIAN 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 1:1351 W PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5031
Mailing Address - Country:US
Mailing Address - Phone:208-888-7049
Mailing Address - Fax:208-888-7246
Practice Address - Street 1:1351 W PINE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5031
Practice Address - Country:US
Practice Address - Phone:208-888-7049
Practice Address - Fax:208-888-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8041302Medicaid
ID805698600Medicaid
ID=========OtherAETNA LIFE INS
ID=========OtherAETNA US HEALTHCARE
ID=========OtherAMER PIONEER LIFE
ID=========OtherCIGNA
ID=========OtherBC/BS OF UTAH
ID=========OtherGLOBAL LIFE
ID=========OtherALLSTATE INS
ID=========OtherAMER INCOME LIFE INS
ID=========OtherGREAT WEST LIFE
ID805698600Medicaid
ID=========OtherCENTRAL STATES HEALTH & L
ID=========OtherADMINISTRATORS WEST
ID=========OtherBOISE CASCADE CORP
ID=========OtherAFLAC
ID=========OtherASSOC. FOR LUTHERANS
ID=========OtherAMER REPLUC INS
ID=========OtherASSOC FOOD STORES
ID805698600Medicaid