Provider Demographics
NPI:1629007794
Name:BRIGHTON BRIDGE HOSPICE LLC
Entity Type:Organization
Organization Name:BRIGHTON BRIDGE HOSPICE LLC
Other - Org Name:BRIGHTON BRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-6600
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70655-0279
Mailing Address - Country:US
Mailing Address - Phone:337-639-9200
Mailing Address - Fax:337-639-3032
Practice Address - Street 1:213 NORTH FIRST ST
Practice Address - Street 2:B
Practice Address - City:OBERLIN
Practice Address - State:LA
Practice Address - Zip Code:70655
Practice Address - Country:US
Practice Address - Phone:337-639-9200
Practice Address - Fax:337-639-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583286Medicaid
LA1583286Medicaid