1952354565 NPI number — SUNBRIDGE REGENCY - NORTH CAROLINA, LLC

Table of content: (NPI 1952354565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952354565 NPI number — SUNBRIDGE REGENCY - NORTH CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNBRIDGE REGENCY - NORTH CAROLINA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952354565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SUN AVE NE
Provider Second Line Business Mailing Address:
COMPLIANCE DEPARTMENT
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-5604
Provider Business Mailing Address Fax Number:
610-612-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-885-0141
Provider Business Practice Location Address Fax Number:
610-612-5327
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VP ASST SECRETARY
Authorized Official Telephone Number:
505-468-4742

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH0389 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 345172 . This is a "MEDCOST/MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17968 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71-08310 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0088K . This is a "STATE BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0088K . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3426348 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3445172 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com