1346775285 NPI number — LIFEBRITE HOSPITAL GROUP OF STOKES, LLC

Table of content: (NPI 1346775285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346775285 NPI number — LIFEBRITE HOSPITAL GROUP OF STOKES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346775285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3853 US 311 HWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE HALL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27042-8184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-427-3076
Provider Business Mailing Address Fax Number:
336-427-3256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3853 US 311 HWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE HALL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27042-8184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-593-5311
Provider Business Practice Location Address Fax Number:
336-593-5350
Provider Enumeration Date:
04/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TILLMAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
PRIDDY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
336-593-5314

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  H0165 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , with the licence number: H0165 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H0165 . This is a "STATE LICENSURE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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