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NPI Code Detail

MEDICARE: SUNBRIDGE REGENCY - NORTH CAROLINA, LLC

MEDICARE: SUNBRIDGE REGENCY - NORTH CAROLINA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH0395NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2345143OTHERMEDCOST/MULTIPLAN
30088KOTHERNCBCBS
40088KOTHERNCSTATE BCBS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
617968.OTHERNCPARTNERS
771-08310OTHERUNITED HEALTHCARE

General Provider Information

NPI Number : 1003869983
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNBRIDGE REGENCY - NORTH CAROLINA, LLC
Provider Business Mailing Address
First Line : 101 SUN AVE NE
Second Line : COMPLIANCE DEPARTMENT
City : ALBUQUERQUE
State : NM
Zip : 87109-4373
Country : US
Telephone Number : 505-468-5604
Fax Number : 505-468-4681
Provider Business Practice Location Address
First Line : 900 W DOLPHIN ST
Second Line :
City : SILER CITY
State : NC
Zip : 27344-3711
Country : US
Telephone Number : 919-663-3431
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : MICHAEL T BERG
Credential :
Telephone Number : 505-468-4742
Provider Enumeration Date : 05/19/2006
Last Update Date : 06/23/2025

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