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Organization
SUNBRIDGE REGENCY - TENNESSEE, LLC
Active
Organization
SUNBRIDGE REGENCY - TENNESSEE, LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Willow Ridge Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
MICHAEL T BERG (SECRETARY)
(610) 444-6350
Entity
Organization
Contact information
Practice address
215 RICHARDSON WAY, MAYNARDVILLE, TN 37807-3803
(865) 992-5816
(865) 992-4031
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
0000000276
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445284
—
TN
01
—
166895
BLUE CROSS BLUE SHIELD
TN
05
—
7440459
—
TN
Enumeration date
05/28/2006
Last updated
06/24/2025
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