Organization
COUNTRYSIDE CARE CENTER CORP.
Active
Parent organization
SUNBRIDGE HEALTHCARE CORPORATION
Other names
Harborside Healthcare - Terre Haute Rehabilitation and Nursing Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE CORPORATION
Authorized official
WILLIAM A MATHIES (PRESIDENT DIRECTOR)
(505) 821-3355
Entity
Organization
Contact information
Practice address
1001 E SPRINGHILL DR, TERRE HAUTE, IN 47802-4547
(812) 238-2441
(812) 299-4492
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
05-000119-2
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100266680A
—
IN
Enumeration date
07/09/2006
Last updated
10/09/2008
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