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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 Facility10311360GA

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 : 1255381042
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNBRIDGE RETIREMENT CARE ASSOCIATES 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 : 315 UPPER RIVERDALE RD SW
Second Line :
City : RIVERDALE
State : GA
Zip : 30274-2500
Country : US
Telephone Number : 770-991-1050
Fax Number : 770-991-1008
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : WILLIAM A. MATHIES
Credential :
Telephone Number : 505-821-3355
Provider Enumeration Date : 05/11/2006
Last Update Date : 09/29/2009

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Directions to “SUNBRIDGE RETIREMENT CARE ASSOCIATES LLC ” Practice Location

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