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General NPI Number Information
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NPI Number | 1881641389
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Entity Type | Organization
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Legal Business Name | SUNBRIDGE REGENCY - TENNESSEE LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 136 DAVIS LANE
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City | LA FOLLETTE
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State | TN
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Zip | 37766-3118
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Country | US
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Telephone | 423-562-0760
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Fax | 423-562-6709
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Provider Business Mailing Address
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Address Line | 101 SUN AVE NE COMPLIANCE DEPARTMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4373
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Country | US
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Telephone | 505-468-5604
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Fax | 505-468-4681
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Authorized Official
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Title or Position | SECRETARY
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Name | MICHAEL T BERG
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Credential |
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Telephone | 610-444-6350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 00000019
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 00000019
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License Number State | TN
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