Organization
SUNBRIDGE WEST TENNESSEE, LLC.
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Trenton Place Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
THOMAS DIVITTORIO (PRESIDENT DIRECTOR)
(505) 821-3355
Entity
Organization
Contact information
Practice address
2036 US HIGHWAY 45 BYP S, TRENTON, TN 38382-2941
(731) 855-4500
(731) 855-2722
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
0000000090
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445308
—
TN
01
—
3004697
BLUE CROSS/BLUE SHIELD OF
TN
05
—
7440445
—
TN
Enumeration date
05/28/2006
Last updated
08/17/2018
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