Healthcare Provider Details

I. General information

NPI: 1285685362
Provider Name (Legal Business Name): SUNBRIDGE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JOHN ALDRIDGE DR
TUSCUMBIA AL
35674-3000
US

IV. Provider business mailing address

500 JOHN ALDRIDGE DR
TUSCUMBIA AL
35674-3000
US

V. Phone/Fax

Practice location:
  • Phone: 256-383-4541
  • Fax: 256-383-2966
Mailing address:
  • Phone: 256-383-4541
  • Fax: 256-383-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16644
License Number StateAL

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752