MEDICARE: SUNBRIDGE MEADOWBROOK REHABILITATION CENTER

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	910000080	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1891742946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNBRIDGE MEADOWBROOK REHABILITATION CENTER

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	:	3951 EAST BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4605
Country	:	US
Telephone Number	:	310-391-8266
Fax Number	:	310-390-9878

Authorized Official
Title or Position	:	CFO, TREASURER, ASST SECRETARY
Name	:	THOMAS DIVITORRIO
Credential	:
Telephone Number	:	505-468-4742

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/21/2014

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