# SUNBRIDGE REGENCY - TENNESSEE, LLC

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

## Provider details

- **NPI number:** 1871540385
- **Legal business name:** SUNBRIDGE HEALTHCARE LLC
- **Authorized official:** MICHAEL T BERG (SECRETARY)
- **Authorized official phone:** (610) 444-6350

## Contact information

- **Practice address:** 215 RICHARDSON WAY, MAYNARDVILLE, TN 37807-3803
- **Practice address phone:** (865) 992-5816
- **Practice address fax:** (865) 992-4031
- **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 | 0000000276 | TN | Yes |

## Other

- **Enumeration date:** 05/28/2006
- **Last updated:** 06/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445284 | — | TN |
| 01 | — | 166895 | BLUE CROSS BLUE SHIELD | TN |
| 05 | — | 7440459 | — | TN |