Provider Demographics
NPI:1801843560
Name:SUNBRIDGE CARE ENTERPRISES WEST
Entity Type:Organization
Organization Name:SUNBRIDGE CARE ENTERPRISES WEST
Other - Org Name:SUNBRIDGE CARE & REHAB FOR RED BLUFF
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:505-821-3355
Mailing Address - Street 1:101 SUN AVE NE
Mailing Address - Street 2:
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 1:555 LUTHER RD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4256
Practice Address - Country:US
Practice Address - Phone:530-527-6232
Practice Address - Fax:530-527-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06274HMedicaid
CA1612OtherAETNA
CAZZR06274HMedicaid
CA=========OtherAARP
CA=========OtherBLUE CROSS FERDERAL
CA=========OtherBLUE CROSS FERDERAL