# SUNBRIDGE GLENVILLE HEALTH CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUNBRIDGE CARE ENTERPRISES LLC
- **Other names:** Glenville Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932156460
- **Legal business name:** SUNBRIDGE CARE ENTERPRISES LLC
- **Authorized official:** MICHAEL T BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4752

## Contact information

- **Practice address:** 111 FAIRGROUND RD, GLENVILLE, WV 26351-1388
- **Practice address phone:** (304) 462-5718
- **Practice address fax:** (304) 462-8272
- **Mailing address:** 101 E STATE ST, COMPLIANCE DEPARTMENT, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (505) 468-4742
- **Mailing address fax:** (505) 468-8742

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 94 | WV | — |
| 314000000X | Skilled Nursing Facility | 94 | WV | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | \#001703821 | BCBS | WV |
| 05 | — | 0004026000 | — | WV |