Provider Demographics
NPI:1851348387
Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC
Other - Org Name:WILLOWS AT WINCHESTER 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:505-821-3355
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 1:32 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2400
Practice Address - Country:US
Practice Address - Phone:931-967-0200
Practice Address - Fax:931-962-4224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000083314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440506Medicaid
TN0445319Medicaid
TN#3003770OtherBLUE CROSS/BLUE SHIELD OF
445319OtherSTERLING OPTION I- MEDICA
TN#3003770OtherBLUE CROSS/BLUE SHIELD OF
=========OtherAARP
=========OtherAMA INS
=========OtherBC OF IL
=========OtherCIGNA
=========OtherHARTFORD
TN0445319Medicaid
=========OtherBANKERS LIFE
=========OtherMUTUAL OF OMAHA
445319OtherSTERLING OPTION I- MEDICA
=========OtherPHYSICIANS MUTUAL
=========OtherJOHN DEERE
=========OtherSTANDARD LIFE
TN7440506Medicaid
=========OtherAPWU