Organization
SUNBRIDGE HEALTHCARE LLC
Active
Other names
Cherry Ridge Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
501 W IDAHO BLVD, EMMETT, ID 83617-9694
(208) 365-3597
(208) 365-5107
Mailing address
501 W IDAHO BLVD, EMMETT, ID 83617-9694
(208) 365-3597
(208) 365-5107
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
34
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010012586
BLUE SHIELD OF IDAHO
ID
05
—
0029214
—
ID
01
—
01867
BLUE CROSS OF IDAHO
ID
Enumeration date
05/26/2006
Last updated
03/27/2017
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