Healthcare Provider Details

I. General information

NPI: 1629007794
Provider Name (Legal Business Name): BRIGHTON BRIDGE HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NORTH FIRST ST B
OBERLIN LA
70655
US

IV. Provider business mailing address

PO BOX 279
OBERLIN LA
70655-0279
US

V. Phone/Fax

Practice location:
  • Phone: 337-639-9200
  • Fax: 337-639-4030
Mailing address:
  • Phone: 337-639-9200
  • Fax: 337-639-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-439-6600