Provider Demographics
NPI:1053367367
Name:SUNBRIDGE HEALTHCARE LLC
Entity type:Organization
Organization Name:SUNBRIDGE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-821-3355
Mailing Address - Street 1:101 SUN AVE NE
Mailing Address - Street 2:COMPLIANCE DEPARTMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4373
Mailing Address - Country:US
Mailing Address - Phone:505-468-5604
Mailing Address - Fax:505-468-4681
Practice Address - Street 1:640 FILER AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4533
Practice Address - Country:US
Practice Address - Phone:208-734-8645
Practice Address - Fax:208-734-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID32311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8750370802OtherAMERICAN PIONEER
ID8750370802OtherAPWU HEALTH PLAN
ID8750370802OtherCIGNA
ID8750370802OtherDMBA/SE IDAHO EMP COALITI
ID8750370802OtherFARMER STOCKMAN
ID01305OtherBLUE CROSS OF IDAHO
ID8750370802OtherBLUE CROSS /BLUE SHIELD
ID8750370802OtherEQUITABLE LIFE & CASUALTY
ID000010013057OtherBLUE SHIELD OF IDAHO
ID8750370802OtherAARP GROUP HEALTH
ID8750370802OtherBC/BS OF MN
ID8750370802OtherCHAMPUS
ID8750370802OtherAETNA LIFE INS CO
ID8750370802OtherBC/BS OF UTAH
ID8750370802OtherFEDERAL HOME LIFE INS
ID0029215Medicaid
ID8750370802OtherBANKERS LIFE & CASUALTY
ID8750370802OtherBC/BS OF MI
ID8750370802OtherDESERET MUTUAL BENEFITS
ID8750370802OtherDMBA/SE IDAHO EMP COALITI