MEDICARE: LIGHTBRIDGE HOSPICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	080000772	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154320299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTBRIDGE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	6155 CORNERSTONE CT E
Second Line	:	SUITE 220
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4737
Country	:	US
Telephone Number	:	858-458-2992
Fax Number	:	858-458-3655

Provider Business Practice Location Address
First Line	:	6155 CORNERSTONE COURT EAST
Second Line	:	SUITE 220
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4737
Country	:	US
Telephone Number	:	858-458-2992
Fax Number	:	858-458-3655

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JILL MENDLEN
Credential	:	CEO
Telephone Number	:	858-458-2992

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/06/2011

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