Provider Demographics
NPI:1801843313
Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC
Other - Org Name:FAYETTEVILLE CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-5013
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 1:4081 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2674
Practice Address - Country:US
Practice Address - Phone:931-433-9973
Practice Address - Fax:931-433-4693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-28
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000305314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
445320OtherAARP
TN#3033966OtherBLUE CROSS/BLUE SHIELD OF
TN7440356Medicaid
TN0445320Medicaid
445320OtherAARP
TN#3033966OtherBLUE CROSS/BLUE SHIELD OF
=========OtherCIGNA H.C.
=========OtherUNITED AMERICAN
TN7440356Medicaid
=========OtherCONTINENTAL LIFE
TN0445320Medicaid
=========OtherMUTUAL OF OMAHA
=========OtherUNITED TEACHERS ASSOCIATE