Organization
SUNBRIDGE BECKLEY HEALTH CARE LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Pine Lodge Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
MICHAEL BERG (ASSISTANT SECRETARY)
(505) 821-3355
Entity
Organization
Contact information
Practice address
405 STANAFORD RD, BECKLEY, WV 25801-3143
(304) 252-6317
(304) 253-4140
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
313M00000X
Nursing Facility/Intermediate Care Facility
18
WV
314000000X
Skilled Nursing Facility
Primary
18
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004048000
—
WV
Enumeration date
05/30/2006
Last updated
07/13/2015
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