Healthcare Provider Details

I. General information

NPI: 1194772731
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: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMPTON RD
EXETER NH
03833-4859
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 603-772-5251
  • Fax: 603-778-1024
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number02694
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number02694
License Number StateNH

VIII. Authorized Official

Name: WILLIAM A MATHIES
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 505-468-5013