Healthcare Provider Details

I. General information

NPI: 1275520751
Provider Name (Legal Business Name): BRIGHTMOOR HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 NEWNAN RD
GRIFFIN GA
30223-7114
US

IV. Provider business mailing address

3247 NEWNAN RD
GRIFFIN GA
30223-7114
US

V. Phone/Fax

Practice location:
  • Phone: 770-467-9930
  • Fax: 770-467-9932
Mailing address:
  • Phone: 770-467-9930
  • Fax: 770-467-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number111618
License Number StateGA

VIII. Authorized Official

Name: WILLAM C BROWN
Title or Position: CEO
Credential:
Phone: 678-972-1642