Organization
HBR LEWISPORT, LLC
Active
Parent organization
SUNBRIDGE HEALTHCARE LLC
Other names
Heartland Villa Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE HEALTHCARE LLC
Authorized official
THOMAS DIVITTORIO (CFO, TREASURER, ASST SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
8005 US HIGHWAY 60 W, LEWISPORT, KY 42351-7079
(270) 295-6756
(270) 295-6759
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
314000000X
Skilled Nursing Facility
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12505251
—
KY
Enumeration date
08/31/2006
Last updated
01/31/2015
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