Organization
SUNBRIDGE HEALTHCARE LLC
Active
Other names
Lake Ridge Solana Alzheimer's Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BERG (ASSISTANT SECRETARY)
(505) 821-3355
Entity
Organization
Contact information
Practice address
817 E PLUM ST, MOSES LAKE, WA 98837-1870
(509) 765-7835
(509) 765-6705
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
311500000X
Alzheimer Center (Dementia Center)
NH1152
WA
314000000X
Skilled Nursing Facility
Primary
NH1152
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4114435
—
WA
01
—
583
MSC/PREMERA BLUE CROSS
WA
Enumeration date
06/08/2006
Last updated
07/13/2015
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