Healthcare Provider Details

I. General information

NPI: 1487601704
Provider Name (Legal Business Name): SUNBRIDGE STOCKTON REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9107 DAVIS RD
STOCKTON CA
95209-1807
US

IV. Provider business mailing address

9107 DAVIS RD
STOCKTON CA
95209-1807
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-6488
  • Fax:
Mailing address:
  • Phone: 209-478-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000358
License Number StateCA

VIII. Authorized Official

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