Provider Demographics
NPI:1891741930
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:LANGDON PLACE OF DOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HAGER
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 1:60 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4146
Practice Address - Country:US
Practice Address - Phone:603-743-4110
Practice Address - Fax:603-740-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02695310400000X, 311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL305089OtherALABAMA BC BS
ME305089OtherMAINE BC BS
NH30100460Medicaid
NH305089OtherNH BC BS
VT305089OtherVT BC BS
MA305089OtherMASS BC BS
MI305089OtherMICHIGAN BC BS
305089OtherFEDERAL BC BS
CT305089OtherCONN BC BS
=========OtherBANKERS LIFE & CASUALTY
=========OtherAARP
=========OtherEBPA
=========OtherCIGNA
NH30100460Medicaid
VT305089OtherVT BC BS
=========OtherAETNA
=========OtherUNITED HEALTHCARE
=========OtherCENTRAL STATES
ME305089OtherMAINE BC BS
=========OtherEBPA