Organization
SUNBRIDGE REGENCY - TENNESSEE LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Cumberland Village Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
MICHAEL T BERG (SECRETARY)
(610) 444-6350
Entity
Organization
Contact information
Practice address
136 DAVIS LANE, LA FOLLETTE, TN 37766-3118
(423) 562-0760
(423) 562-6709
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
00000019
TN
314000000X
Skilled Nursing Facility
Primary
00000019
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000155310
BLUE CROSS/BLUE SHIELD OF
TN
05
—
0445276
—
TN
01
—
702021736
CARITEN
—
05
—
7440435
—
TN
Enumeration date
05/28/2006
Last updated
06/24/2025
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