Provider Demographics
NPI:1982651758
Name:SUNBRIDGE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:COLUMBIA CREST 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:
Authorized Official - Last Name:BERG
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 1:1100 E NELSON RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2360
Practice Address - Country:US
Practice Address - Phone:509-765-6788
Practice Address - Fax:509-766-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH1151314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4114427Medicaid
WA504OtherPREMERA BC/MSC
WA=========OtherBASIC HEALTH
WA=========OtherCOLONIAL PENN FRANKLIN IN
WA=========OtherBLUE CROSS FEDERAL
WA=========OtherCOMBINED INS O AMER
WA=========OtherAFLAC
WA=========OtherBANKERS LIFE & CASUALTY
WA=========OtherBOEING - AETNA
WA=========OtherCONN GEN LIFE INS CO
WA=========OtherDEFINITY HEALTH
WA4114427Medicaid
WA=========OtherCENTRAL BASIN HOME HEALTH
WA=========OtherAARP
WA=========OtherAETNA
WA=========OtherCITY OF SEATTLE WORK COMP
WA=========OtherCOMMUNITY HEALTH INFORMAT
WA=========OtherAPWU HEALH PLAN
WA=========OtherCOUNTRY COMPANY
WA=========OtherCOMBINED INS O AMER