# SUNBRIDGE MOUNTAIN CARE MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUNBRIDGE HEALTHCARE LLC
- **Other names:** New Martinsville Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689621062
- **Legal business name:** SUNBRIDGE HEALTHCARE LLC
- **Authorized official:** MICHAEL BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4742

## Contact information

- **Practice address:** 225 RUSSELL AVE, NEW MARTINSVILLE, WV 26155-1572
- **Practice address phone:** (304) 455-2600
- **Practice address fax:** (304) 455-2580
- **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 |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 99 | WV | — |
| 314000000X | Skilled Nursing Facility | 99 | WV | Yes |

## Other

- **Enumeration date:** 05/30/2006
- **Last updated:** 08/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0015198000 | — | WV |
| 01 | — | 001703864 | BCBS | WV |