Organization
SUNBRIDGE BRASWELL ENTERPRISES LLC
Active
Parent organization
REGENCY HEALTH SERVICES LLC
Other names
Laurel Park Behavioral Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
REGENCY HEALTH SERVICES LLC
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
1425 LAUREL AVE, POMONA, CA 91768-2837
(909) 622-1069
(909) 622-4319
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
950000064
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT18548G
—
CA
Enumeration date
05/27/2006
Last updated
01/14/2016
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