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Organization

SUNBRIDGE HEALTHCARE LLC

Active
Other names
Payette Center
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization

Contact information

Practice address
1019 3RD AVE S, PAYETTE, ID 83661-2832
(208) 642-4455
Mailing address
1019 3RD AVE S, PAYETTE, ID 83661-2832
(208) 642-4455

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
24
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010013110
REGENCE BLUE SHIELD OF ID
ID
01
01156
BLUE CROSS OF IDAHO
ID
05
8041298
ID
Enumeration date
05/27/2006
Last updated
03/28/2017
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