MEDICARE: BRIGHTMOOR 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	111618	GA

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	:	1275520751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTMOOR HOSPICE, LLC

Provider Business Mailing Address
First Line	:	3247 NEWNAN RD
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30223-7114
Country	:	US
Telephone Number	:	770-467-9930
Fax Number	:	770-467-9932

Provider Business Practice Location Address
First Line	:	3247 NEWNAN RD
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30223-7114
Country	:	US
Telephone Number	:	770-467-9930
Fax Number	:	770-467-9932

Authorized Official
Title or Position	:	CEO
Name	:	WILLAM C BROWN
Credential	:
Telephone Number	:	678-972-1642

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	09/29/2022

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