Provider Demographics
NPI:1235662453
Name:LIFEBRITE HOSPITAL GROUP OF ABERDEEN LLC
Entity Type:Organization
Organization Name:LIFEBRITE HOSPITAL GROUP OF ABERDEEN LLC
Other - Org Name:NINA JURNEY FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-505-9657
Mailing Address - Street 1:400 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-3335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 JACKSON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3300
Practice Address - Country:US
Practice Address - Phone:662-369-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health