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General NPI Number Information
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NPI Number | 1639448913
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Entity Type | Organization
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Legal Business Name | BRIGHTMOOR ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 3223 NEWNAN RD
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City | GRIFFIN
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State | GA
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Zip | 30223-7114
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Country | US
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Telephone | 770-227-9950
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Fax | 770-227-9958
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Provider Business Mailing Address
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Address Line | P. O. BOX 965
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City | GRIFFIN
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State | GA
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Zip | 30224-0025
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Country | US
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Telephone | 770-227-9950
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Fax | 770-227-9958
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Authorized Official
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Title or Position | REGIONAL VP OF OPERATIONS
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Name | PENNY GRIFFIN
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Credential |
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Telephone | 770-228-1228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126030031
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License Number State | GA
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