Provider Demographics
NPI:1710933999
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:BALLARD 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 1:820 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2207
Practice Address - Country:US
Practice Address - Phone:206-782-0100
Practice Address - Fax:206-781-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1337314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7080WHOtherREGENCE BLUE SHIELD
WA4114419Medicaid
WA=========OtherPACIFIC CARE
WA=========OtherLABOT & INDUSTRIES
WA=========OtherTRICARE
WA=========OtherWESTERN TEAMSTERS
WA4114419Medicaid
WA=========OtherPREMERA BLUE CROSS
WA=========OtherUNIFORM MEDICAL
WA=========OtherAETNA
WA=========OtherUNITED HEALTHCARE
WA=========OtherFIRST CHOICE
WA=========OtherGREAT WEST LIFE
WA=========OtherAARP
WA=========OtherZENITH ADMIN
WA=========OtherFEDERAL BLUE CROSS
WA=========OtherGROUP HEALTH
WA=========OtherSECURE HORIZONS
WA=========OtherGROUP HEALTH