Healthcare Provider Details

I. General information

NPI: 1538692074
Provider Name (Legal Business Name): LIFEBRITE HOSPITAL GROUP OF ABERDEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CHESTNUT ST
ABERDEEN MS
39730-3335
US

IV. Provider business mailing address

400 S CHESTNUT ST
ABERDEEN MS
39730-3335
US

V. Phone/Fax

Practice location:
  • Phone: 662-369-2455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateMS

VIII. Authorized Official

Name: CHRISTIAN FLETCHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 678-505-9657