# SUNBRIDGE OF HARRIMAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUNBRIDGE HEALTHCARE CORPORATION
- **Other names:** Renaissance Terrace Care and Rehabilitation Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124075650
- **Legal business name:** SUNBRIDGE HEALTHCARE CORPORATION
- **Authorized official:** WILLIAM A. MATHIES (PRESIDENT DIRECTOR)
- **Authorized official phone:** (505) 821-3355

## Contact information

- **Practice address:** 257 PATTON LN, HARRIMAN, TN 37748-8618
- **Practice address phone:** (865) 354-3941
- **Practice address fax:** (865) 354-9966
- **Mailing address:** 101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
- **Mailing address phone:** (505) 468-5604
- **Mailing address fax:** (505) 468-4681

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 0000000212 | TN | Yes |

## Other

- **Enumeration date:** 05/29/2006
- **Last updated:** 09/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0093885 | BLUE CROSS/BLUE SHIELD OF | TN |
| 05 | — | 0445223 | — | TN |
| 01 | — | 100044717 | PHP TENNCARE | — |
| 01 | — | 1682240 | CIGNA | — |
| 01 | — | 445223 | CARITEN | — |
| 01 | — | 7100143 | UNITED HEALTHCARE | — |
| 05 | — | 7440519 | — | TN |