Provider Demographics
NPI:1760432652
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:RIVER CITY 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 1:1350 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4364
Mailing Address - Country:US
Mailing Address - Phone:256-355-6911
Mailing Address - Fax:
Practice Address - Street 1:1350 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4364
Practice Address - Country:US
Practice Address - Phone:256-355-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16974314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47511305Medicaid
UT=========OtherUNITED HEALTHCARE
MD=========OtherMASTER MATES & PILOTS
AL47511305Medicaid
GA=========OtherAARP
IL=========OtherFIRST HEALTH
NE=========OtherMUTUAL OF OMAHA
NE=========OtherPHYSICAN MUTUAL
OH=========OtherUNITED MEDICAL RESOURCES
AL=========OtherBC/BS AL,TN, OK,
KY=========OtherHUMANA
TX=========OtherNEW ERA LIFE
OH=========OtherSTATE FARM
TX=========OtherLIFE INVESTORS
TX=========OtherUNITED AMERICAN INS.
AL=========AOtherFIRST COMMUNITY HEALTH
AL47511305Medicaid