Sunbridge Braswell Enterprises LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

950000080 Issued in CA

Legal business name

SUNBRIDGE BRASWELL ENTERPRISES LLC

Doing business as

Olive Vista, Ctr for Problems of Lvgs

Practice address

2335 S Towne Ave
Pomona, CA 91766-6227

Phone

(909) 628-6024

Fax

(909) 628-1839

NPI assigned

May 27, 2006

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Berg

Title

Assistant Secretary

Phone

(505) 468-4742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Olive Vista, Ctr for Problems of Lvgs Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Laurel Park Behavioral Health Center3 organizations share this tax ID, including this one

Part of

Terrace Hghts Nursing H

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Sunbridge Braswell Enterprises LLC

  dba Laurel Park Behavioral Health Center

  • Skilled Nursing Facility
  • Pomona, CA
  • NPI 1639126782
  NPD tax ID
• Sunbridge Braswell Enterprises, Inc.

  dba Sierra Vista

  • Skilled Nursing Facility
  • Highland, CA
  • NPI 1326094665
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1336196484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 S TOWNE AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917666227",
            "telephone_number": "909-628-6024",
            "fax_number": "909-628-1839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE BRASWELL ENTERPRISES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE LLC",
        "enumeration_date": "2006-05-27",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18630F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olive Vista, Ctr for Problems of Lvgs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Summerlin
• May I Hsuan Sun, ADC
• Qin Sun
• Ruth Sun
• Rachel Christina Sunarta
• Sunbridge Braswell Enterprises LLC (Laurel Park Behavioral Health Center)
• Ki Hun Sung
• Ting-I Sung
• Yusuf Khan Suri
• Gloria Sustaita

• Skilled Nursing Facility in Pomona, CA
• Providers in Pomona, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.