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
1	314000000X	Skilled Nursing Facility	NH0401	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0088K	OTHER	NC	BCBS
2	17968.	OTHER	NC	PARTNERS
3	0088K	OTHER	NC	STATE BCBS
4	345126	OTHER		MEDCOST/MULTIPLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	71-08310	OTHER	NC	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1649224056
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	:	228 SMITH CHAPEL RD
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1917
Country	:	US
Telephone Number	:	919-658-9522
Fax Number	:	919-658-5893

Authorized Official
Title or Position	:	SECRETARY
Name	:	MICHAEL T BERG
Credential	:
Telephone Number	:	610-444-6350

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	06/24/2025

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