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NPI Code Detail

MEDICARE: SUNBRIDGE RETIREMENT CARE ASSOCIATES, LLC

MEDICARE: SUNBRIDGE RETIREMENT CARE ASSOCIATES, 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 Facility11061414GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174574164
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNBRIDGE RETIREMENT CARE ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 101 E STATE ST
Second Line : REIMBURSEMENT DEPARTMENT
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number : 610-444-6350
Fax Number : 610-444-4395
Provider Business Practice Location Address
First Line : 5131 WARM SPRINGS RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4196
Country : US
Telephone Number : 706-561-1371
Fax Number : 706-561-4055
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : THOMAS DIVITTORIO
Credential :
Telephone Number : 610-444-6350
Provider Enumeration Date : 05/13/2006
Last Update Date : 07/28/2014

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