Healthcare Provider Details

I. General information

NPI: 1366499063
Provider Name (Legal Business Name): SUNBRIDGE HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10786 LIVE OAK AVE
TEMPLE CITY CA
91780-2944
US

IV. Provider business mailing address

101 SUN AVE NE
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-3553
  • Fax: 626-447-0779
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM A. MATHIES
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 505-821-3355