Provider Demographics
NPI:1346775285
Name:LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Entity Type:Organization
Organization Name:LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Other - Org Name:LIFEBRITE FAMILY MEDICAL & URGENT CARE OF PINE HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:PRIDDY
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-593-5314
Mailing Address - Street 1:3853 US 311 HWY N
Mailing Address - Street 2:
Mailing Address - City:PINE HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27042-8184
Mailing Address - Country:US
Mailing Address - Phone:336-427-3076
Mailing Address - Fax:336-427-3256
Practice Address - Street 1:3853 US 311 HWY N
Practice Address - Street 2:
Practice Address - City:PINE HALL
Practice Address - State:NC
Practice Address - Zip Code:27042-8184
Practice Address - Country:US
Practice Address - Phone:336-593-5311
Practice Address - Fax:336-593-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0165261QR1300X, 261QU0200X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH0165OtherSTATE LICENSURE