HBR Bardwell, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HBR BARDWELL, LLC

Doing business as

Countryside Care and Rehabilitation Center

Practice address

47 Margo Ave
Bardwell, KY 42023-9005

Phone

(270) 628-5424

Fax

(270) 628-0311

NPI assigned

Aug 31, 2006

Last updated

Sep 30, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

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

Authorized official

Name

William A Mathies

Title

President Director

Phone

(505) 821-3355

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Countryside Care and Rehabilitation Center Doing business as

Part of

Sunrise HLTH Care Corp

Member of 1

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

• Sunbridge Healthcare LLC

  dba Columbia Crest Center

  • Skilled Nursing Facility
  • Moses Lake, WA
  • NPI 1982651758

  Member Of

  NPD member

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1851402093",
    "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": "47 MARGO AVE",
            "city": "BARDWELL",
            "state": "KY",
            "postal_code": "420239005",
            "telephone_number": "270-628-5424",
            "fax_number": "270-628-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HBR BARDWELL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-08-31",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12505244",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gabrielle A Roberts, DMD
• Cindy Shankle

• Skilled Nursing Facility in Bardwell, KY
• Providers in Bardwell, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.