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General NPI Number Information
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NPI Number | 1790732337
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Entity Type | Organization
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Legal Business Name | SUNBRIDGE HEALTHCARE LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 2609 SUNNYBROOK DR
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City | NAMPA
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State | ID
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Zip | 83686-6332
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Country | US
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Telephone | 208-467-7298
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Fax | 208-463-0901
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Provider Business Mailing Address
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Address Line | 2609 SUNNYBROOK DR
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City | NAMPA
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State | ID
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Zip | 83686-6332
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Country | US
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Telephone | 208-467-7298
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Fax | 208-463-0901
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 46
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 46
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 46
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License Number State | ID
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