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CAH111314-01 LifeBrite Hospital Group of Early, LLC D/B/A LifeBrite Community Hospital of Early, LLC (Terminated)
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Main Details
Name
LifeBrite Hospital Group of Early, LLC D/B/A LifeBrite Community Hospital of Early, LLC
Subdivision Name
EARLY MEMORIAL NURSING HOME
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH111314-01
Medicare Provider Number
111314
Outpatient Facility Provider Number
115271
Additional Details
Current Program Status
Terminated
Registration Date
9/27/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
Last Recertification Date
11/22/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
LifeBrite Hospital Group of EArly, LLC
Ginger Maddox Cushing, administrator
(229) 724-4235
Primary Contact
Lifebrite Hospital Group of Early, LLC
Stacey Gale, Pharmacist
(229) 724-4208
Addresses
Street Address
11740 COLUMBIA ST.
BLAKELY, GA 39823
Billing Address
LifeBrite Hospital Group, LLC
3970 Five Forks Trickum Rd SW ste A
Lilburn, GA 30047
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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