Healthcare Provider Details

I. General information

NPI: 1902853740
Provider Name (Legal Business Name): SUNBRIDGE HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E DUNSTABLE RD
NASHUA NH
03062-4207
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 603-888-7878
  • Fax: 603-888-5201
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 Number02692
License Number StateNH

VIII. Authorized Official

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