MEDICARE: LIFEBRIDGE INTERGRATED CARE SERVICES, 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700278850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRIDGE INTERGRATED CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	2443 NC HIGHWAY 20
Second Line	:
City	:	SAINT PAULS
State	:	NC
Zip	:	28384-8652
Country	:	US
Telephone Number	:	312-730-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 PROFESSIONAL DR
Second Line	:	SUITE D
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	312-730-0662
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. SHEILA MURPHY
Credential	:
Telephone Number	:	312-730-0662

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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