Organization
PINE TREE VILLA, LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Regis Woods
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
4604 LOWE RD, LOUISVILLE, KY 40220-1514
(502) 451-1401
(502) 485-1999
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
100503
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12504882
—
KY
Enumeration date
08/17/2006
Last updated
08/19/2016
About Stedi
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