Provider Demographics
NPI:1104369081
Name:LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Entity Type:Organization
Organization Name:LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Other - Org Name:LIFEBRITE PEDIATRIC CLINIC OF DANBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-593-5311
Mailing Address - Street 1:1030 HOSPICE DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-7379
Mailing Address - Country:US
Mailing Address - Phone:336-593-5354
Mailing Address - Fax:336-593-5331
Practice Address - Street 1:1030 HOSPICE DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016-7379
Practice Address - Country:US
Practice Address - Phone:336-593-5354
Practice Address - Fax:336-593-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH0165OtherHOSPITAL LICENSURE
NCG557OtherMEDICARE PART B PTAN