Healthcare Provider Details

I. General information

NPI: 1396791463
Provider Name (Legal Business Name): SUNBRIDGE HARBOR VIEW REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 W 14TH ST
LONG BEACH CA
90813-2943
US

IV. Provider business mailing address

101 E STATE ST REIMBURSEMENT
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-8701
  • Fax: 562-591-0235
Mailing address:
  • Phone: 505-468-4742
  • Fax: 505-468-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000148
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 505-821-3355