Provider Demographics
NPI:1093702565
Name:BRIGHTMOOR HEALTH CARE INC
Entity Type:Organization
Organization Name:BRIGHTMOOR HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-228-8599
Mailing Address - Street 1:3235 NEWNAN RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-7114
Mailing Address - Country:US
Mailing Address - Phone:770-228-8599
Mailing Address - Fax:770-228-6618
Practice Address - Street 1:3235 NEWNAN RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-7114
Practice Address - Country:US
Practice Address - Phone:770-228-8599
Practice Address - Fax:770-228-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11261150314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000140412AMedicaid
GA000140412AMedicaid