MEDICARE: SUNBRIDGE RETIREMENT CARE ASSOCIATES

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0000000091	TN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	13729	OTHER		1ST COMMUNITY
4	003004969	OTHER	TN	BLUE CROSS/BLUE SHIELD OF

NPI Number	:	1831146349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNBRIDGE RETIREMENT CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	25385 MAIN ST
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-3155
Country	:	US
Telephone Number	:	931-427-2190
Fax Number	:	931-427-2177

Provider Business Practice Location Address
First Line	:	25385 MAIN ST
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-3155
Country	:	US
Telephone Number	:	931-427-2143
Fax Number	:	931-427-7268

Authorized Official
Title or Position	:	CEO DIRECTOR
Name	:	GEORGE HAGAR
Credential	:
Telephone Number	:	610-444-6350

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	01/21/2014

25495 MAIN ST
ARDMORE, TN
38449-3155

Practice Phone: 931-427-6969
Practice Fax: 931-427-6967

25385 MAIN ST
ARDMORE, TN
38449-3155