Provider Demographics
NPI:1932199007
Name:SUNBRIDGE CARE ENTERPRISES LLC
Entity Type:Organization
Organization Name:SUNBRIDGE CARE ENTERPRISES LLC
Other - Org Name:PARKERSBURG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
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 1:1716 GIHON RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-485-5511
Practice Address - Fax:304-485-3511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004257000Medicaid
KY=========OtherAETNA
TX=========OtherAETNA
TX=========OtherUNITED HEALTHCARE
PA=========OtherAETNA
TX=========OtherUNITED AMERICAN INSURANCE
VA=========OtherSTATE FARM
TN=========OtherCIGNA
GA=========OtherUNITED HEALTHCARE
WV0004257000Medicaid
NC=========OtherAETNA US HEALTHCARE
GA=========OtherAMERICAN FAMILY LIFE EQUA
OH=========OtherAETNA
SC=========OtherKANAWHA INSURANCE CO
GA=========OtherAARP UNITED HEALTHCARE
WV=========OtherACORDIA NATIONAL
TX=========OtherUNITED AMERICAN INSURANCE