Organization
SUNBRIDGE GLENVILLE HEALTH CARE LLC
Active
Parent organization
SUNBRIDGE CARE ENTERPRISES LLC
Other names
Glenville Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUNBRIDGE CARE ENTERPRISES LLC
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
111 FAIRGROUND RD, GLENVILLE, WV 26351-1388
(304) 462-5718
(304) 462-8272
Mailing address
101 E STATE ST, COMPLIANCE DEPARTMENT, KENNETT SQUARE, PA 19348-3109
(505) 468-4742
(505) 468-8742
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
94
WV
314000000X
Skilled Nursing Facility
Primary
94
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#001703821
BCBS
WV
05
—
0004026000
—
WV
Enumeration date
05/30/2006
Last updated
08/17/2018
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