BRIGHTMOOR HOSPICE LLC NPI 1275520751

NPI Information

NPI: 1275520751
Provider Name: BRIGHTMOOR HOSPICE, LLC
Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

CLIA Number: 11D1033014

Address:
3247 NEWNAN RD
GRIFFIN, GA
ZIP 30223
Phone: (770) 467-9930
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BRIGHTMOOR HOSPICE, LLC is a hospice care community based in Griffin, GA. BRIGHTMOOR HOSPICE, LLC NPI is 1275520751. The provider is registered as an organization entity type.

The provider's business location address is:

3247 NEWNAN RD
GRIFFIN, GA
ZIP 30223-114
Phone: (770) 467-9930
Fax: (770) 467-9932

The provider's authorized official is Willam C Brown .
The authorized official title is Ceo and has the following contact phone number (678) 972-1642.

The CLIA number assigned to this NPI record is 11D1033014 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/30/2005 and was last updated on 9/29/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based		111618	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000140412B	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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