Provider Demographics
NPI:1851348635
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:PAYETTE 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 1:1019 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2832
Mailing Address - Country:US
Mailing Address - Phone:208-642-4455
Mailing Address - Fax:
Practice Address - Street 1:1019 3RD AVE S
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2832
Practice Address - Country:US
Practice Address - Phone:208-642-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID24314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID01156OtherBLUE CROSS OF IDAHO
ID000010013110OtherREGENCE BLUE SHIELD OF ID
ID8041298Medicaid
ID=========OtherEQUITABLE LIFE
ID01156OtherBLUE CROSS OF IDAHO
ID=========OtherAMERICAN REPUBLIC INS CO
ID=========OtherBANKERS LIFE & CASUALTY
ID=========OtherDESERET MUTUAL
ID=========OtherFEDERAL BLUE CROSS
ID=========OtherBLUE CROSS BLUE SIELD OF
ID=========OtherPHYSICIALNS MUTUAL
ID=========OtherAETNA INS
ID8041298Medicaid
ID000010013110OtherREGENCE BLUE SHIELD OF ID
ID=========OtherODS HEALTH PLAN
ID=========OtherREGENCE BC/BS OF UT
ID=========OtherHEART 'N HOME
ID=========OtherMUTUAL OF OMAHA
ID=========OtherFEDERAL BLUE CROSS