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Organization
SUNRISE HEALTHCARE CORPORATION
Active
Organization
SUNRISE HEALTHCARE CORPORATION
Active
Other names
SunBridge Care & Rehab Hillside
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM A MATHIES (PRESIDENT DIRECTOR)
(505) 821-3355
Entity
Organization
Contact information
Practice address
3641 MEMORIAL BLVD, KINGSPORT, TN 37664-3422
(423) 246-2411
(423) 246-8997
Mailing address
101 SUN AVE NE, COMPLIANCE DEPARTMENT, ALBUQUERQUE, NM 87109-4373
(505) 468-5604
(505) 468-4681
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0000000264
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445295
—
TN
01
—
330690226
JOHN DEERE
—
01
—
62647
BLUE CROSS/BLUE SHIELD OF
TN
05
—
7440436
—
TN
Enumeration date
05/28/2006
Last updated
07/01/2008
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