Sunbridge Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

46 Issued in ID

Legal business name

SUNBRIDGE HEALTHCARE LLC

Practice address

2609 Sunnybrook Dr
Nampa, ID 83686-6332

Phone

(208) 467-7298

Fax

(208) 463-0901

NPI assigned

May 28, 2006

Organization subpart

No

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

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• Sunny Ridge Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Sunbridge Healthcare LLC

  • Skilled Nursing Facility
  • Tuscumbia, AL
  • NPI 1285685362

  Member Of

  NPD member

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1790732337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2609 SUNNYBROOK DR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866332",
            "telephone_number": "208-467-7298",
            "fax_number": "208-463-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2609 SUNNYBROOK DR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866332",
            "telephone_number": "208-467-7298",
            "fax_number": "208-463-0901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ID",
            "license": "46",
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "ID",
            "license": "46",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "46",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8056570",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "02188",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029216",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRUE BLUE",
            "identifier": "02188",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010022479",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunny Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kermit C Sullivan III, ATC
• Leann Sullivan
• Sabrina Sultana
• Stacy I Summa, PA C
• Summit Psychiatry and Family Wellness
• Michelle Colleen Sundquist, LCPC
• Nicole Sundstrom, LPC
• Ali Sup, DO
• Superior Medical Service, PLLC
• Alicia Mary Suski, M.D.

• Skilled Nursing Facility in Nampa, ID
• Providers in Nampa, ID by specialty
• Skilled Nursing Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.