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CAH111314-03 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
LifeBrite Behavioral Health Unit
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH111314-03
Medicare Provider Number
111314
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/19/2014
Last Recertification Date
11/29/2017
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
Pioneer Health Services
Carter Ilgenfritz, Corp. Dir. of Pharmacy Programs
(601) 849-6440 Ext: 339
Addresses
Street Address
11740 Columbia Street
BLAKELY, GA 39823
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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