Provider Demographics
NPI:1831146349
Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES
Entity Type:Organization
Organization Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES
Other - Org Name:ARDMORE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-6350
Mailing Address - Street 1:25385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3155
Mailing Address - Country:US
Mailing Address - Phone:931-427-2190
Mailing Address - Fax:931-427-2177
Practice Address - Street 1:25385 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3155
Practice Address - Country:US
Practice Address - Phone:931-427-2143
Practice Address - Fax:931-427-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000091314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445321Medicaid
TN7440277Medicaid
13729Other1ST COMMUNITY
TN003004969OtherBLUE CROSS/BLUE SHIELD OF
13729Other1ST COMMUNITY