NPIMap

Organization Active NPI

Sunbridge Regency - Tennessee, LLC

Doing business as Willow Ridge Center

  • Skilled Nursing Facility
  • Maynardville, TN
National Provider Identifier
1871540385
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0000000276 Issued in TN
Legal business name
SUNBRIDGE REGENCY - TENNESSEE, LLC
Doing business as
Willow Ridge Center
Practice address
215 Richardson Way
Maynardville, TN 37807-3803
Phone
(865) 992-5816
Fax
(865) 992-4031
NPI assigned
May 28, 2006
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNBRIDGE HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Michael T Berg
Title
Secretary
Phone
(610) 444-6350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0000000276 TN Primary

Addresses

Primary practice location

215 Richardson Way
Maynardville, TN 37807-3803

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 3

IdentifierTypeStateIssuer
166895OtherTNBLUE CROSS BLUE SHIELD
7440459MedicaidTN
0445284MedicaidTN

Other names 1

  • Willow Ridge Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090327000266 TN Part A Provider - Skilled Nursing Facility 9133223852 Practice locations: Maynardville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871540385. Details of each certification follow.

Skilled nursing facility certification: CCN 445284

Legal name
SUNBRIDGE REGENCY - TENNESSEE, LLC
Doing business as
WILLOW RIDGE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 27, 1992
Last certification
Jun 1, 2023
Beds
77
Ownership / control type
Corporation
Multi-facility organization
Genesis Healthcare
Organization structure
CorporationProprietary
Incorporated
Jan 16, 1996 in TN
Enrollment address
215 Richardson Way
Maynardville, TN 37807-3803
Nursing home name
WILLOW RIDGE CENTER
Affiliated entity
GENESIS HEALTHCARE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Willow Ridge CenterCCN 445284 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 27, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7762.9 residents per day on average
Chain
Genesis Healthcare184 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0659213Sunbridge Regency-Tennessee LLC215 Richardson Way, Maynardville, TN 37807Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Sunbridge Regency - Tennessee LLC2 organizations share this tax ID, including this one
Part of
Sunrise HLTH Care Corp

Other organizations with this tax ID 1

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

Member of 1

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Bridgeford Individual Corporate OfficerTreasurer Apr 1, 2024 100%
Steven a Cupp Individual Operational/Managerial Control May 1, 2022
Adp of the SNF Jan 31, 2025
Organization, Hunt Valley, MD For-profit Adp of the SNF Jan 1, 2021
HCCF Management Group XI LLC Organization, Atlanta, GA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 10.8%
Gen Operations I LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Feb 6, 2025
Gen Operations II LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Sun Healthcare Group, Inc. Organization, Albuquerque, NM Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 65.3%
FC-Gen Operations Investment LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Sundance Rehabilitation Holdco Inc Organization, Kennett Square, PA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 5.2%
Genesis Healthcare LLC Organization, Kennett Square, PA LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Regency Health Services, LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 2, 2015 100%
Welltower Op, LLC Organization, Toledo, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 5.7%
Arnold M Whitman Individual 5% Or Greater Indirect Ownership InterestBoard Member Dec 1, 2012 10.8%
Corporate DirectorBoard Member Dec 1, 2012
Genesis Healthcare Inc Organization, Kennett Square, PA Corporation, LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%
Zac Properties XI LLC Organization, Philadelphia, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 7.6%
Steven E Fishman Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 7.6%
Avi Pinchas Mendelson Individual Corporate OfficerPresident, Cfo Apr 1, 2024 100%
Michael T Berg Individual Corporate OfficerSecretary Dec 1, 2012
Individual Adp of the SNF Jan 31, 2025
Sunbridge Healthcare LLC Organization, Albuquerque, NM LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 1, 2012 100%
Genesis Holdings LLC Organization, Kennett Square, PA LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 2, 2015 100%

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 176

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Sunbridge Regency - Tennessee LLC
    • Skilled Nursing Facility
    • La Follette, TN
    • NPI 1881641389

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Regency Health Services, LLC, Sun Healthcare Group, Inc., Sunbridge

    CMS ownership
  • 1 Sutphin Drive Operations LLC

    dba Marmet Center

    • Skilled Nursing Facility
    • Marmet, WV
    • NPI 1538343710

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 100 Abbeyville Road Operations LLC

    dba Abbeyville Skilled Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Lancaster, PA
    • NPI 1467162172

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 100 Chambers Street Operations LLC

    dba Grandview Center

    • Skilled Nursing Facility
    • Cumberland, RI
    • NPI 1891977625

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 100 W Queen Street Operations LLC

    dba Dallastown Skilled Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Dallastown, PA
    • NPI 1336859040

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 1000 Lincoln Drive Operations LLC

    dba Valley Center

    • Skilled Nursing Facility
    • South Charleston, WV
    • NPI 1558545749

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 1008 Thompson Street Operations LLC

    dba Jersey Shore Skilled Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Jersey Shore, PA
    • NPI 1063122778

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 101 13TH Street Operations LLC

    dba Heritage Center

    • Skilled Nursing Facility
    • Huntington, WV
    • NPI 1912181223

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 1020 South Main Street Operations LLC

    dba Quakertown Center

    • Skilled Nursing Facility
    • Quakertown, PA
    • NPI 1588846893

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Zac Properties XI LLC

    CMS ownership
  • 106 Tyree Street Operations LLC

    dba Ansted Center

    • Skilled Nursing Facility
    • Ansted, WV
    • NPI 1639353816

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 1070 Stouffer Avenue Operations LLC

    dba Chambersburg Skilled Nursing and Rehabilitation Center

    • Skilled Nursing Facility
    • Chambersburg, PA
    • NPI 1780394494

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare Inc, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Sundance Rehabilitation Holdco Inc, Welltower Op, LLC, Zac Properti

    CMS ownership
  • 11 Dairy Lane Operations LLC

    dba Woodmont Center

    • Skilled Nursing Facility
    • Fredericksburg, VA
    • NPI 1982885406

    FC-Gen Operations Investment LLC, Gen Operations I LLC, Gen Operations II LLC, Genesis Healthcare LLC, Genesis Holdings LLC, HCCF Management Group XI LLC, Zac Properties XI LLC

    CMS ownership
View all 176

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1871540385",
    "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": "215 RICHARDSON WAY",
            "city": "MAYNARDVILLE",
            "state": "TN",
            "postal_code": "378073803",
            "telephone_number": "865-992-5816",
            "fax_number": "865-992-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBRIDGE REGENCY - TENNESSEE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE LLC",
        "enumeration_date": "2006-05-28",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "610-444-6350"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "0000000276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "166895",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440459",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445284",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Ridge Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maynardville, TN

Sources for this page

Verify at the official NPI Registry.