Basic Information
| Provider Information | |||||||||
| NPI: | 1003869983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNBRIDGE REGENCY - NORTH CAROLINA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SILER CITY CARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | COMPLIANCE DEPARTMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054685604 | ||||||||
| FaxNumber: | 5054684681 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W DOLPHIN ST | ||||||||
| Address2: | |||||||||
| City: | SILER CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273443711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196633431 | ||||||||
| FaxNumber: | 9196632969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | BERG | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | ASST SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5054684742 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUNBRIDGE HEALTHCARE CORPORATION | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0395 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 345143 | 01 | MEDCOST/MULTIPLAN | OTHER | 3426315 | 05 | NC | MEDICAID | 0088K | 01 | NC | STATE BCBS | OTHER | 71-08310 | 01 | UNITED HEALTHCARE | OTHER | 0088K | 01 | NC | BCBS | OTHER | 17968. | 01 | NC | PARTNERS | OTHER | 3445143 | 05 | NC | MEDICAID |