11D1033014 CLIA NUMBER - BRIGHTMOOR HOSPICE INCORPORATED

Laboratory Demographics

CLIA Number: 11D1033014

Facility Name: BRIGHTMOOR HOSPICE INCORPORATED

Facility Address:
3247 NEWNAN ROAD
GRIFFIN, GA
ZIP 30223
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Facility Phone Number: 678 972-1657

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1275520751

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	11D1033014
LAB Type	Hospice
Facility Name	BRIGHTMOOR HOSPICE INCORPORATED
Street	3247 NEWNAN ROAD
City	GRIFFIN
State	GA
ZIP	30223
Phone	678 972-1657
CertificateType	4
CertificateEffectiveDate	11/3/2022
CertificateExpirationDate	11/2/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024