Organization
SUNBRIDGE HEALTHCARE LLC
Active
Other names
Sunny Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
2609 SUNNYBROOK DR, NAMPA, ID 83686-6332
(208) 467-7298
(208) 463-0901
Mailing address
2609 SUNNYBROOK DR, NAMPA, ID 83686-6332
(208) 467-7298
(208) 463-0901
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
46
ID
311Z00000X
Custodial Care Facility
46
ID
314000000X
Skilled Nursing Facility
Primary
46
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010022479
BLUE SHIELD OF IDAHO
ID
05
—
0029216
—
ID
01
—
02188
BLUE CROSS OF IDAHO
ID
05
—
8056570
—
ID
Enumeration date
05/28/2006
Last updated
03/27/2017
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