Provider Demographics
NPI:1639448913
Name:BRIGHTMOOR ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:BRIGHTMOOR ASSISTED LIVING, 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:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-228-1228
Mailing Address - Street 1:P. O. BOX 965
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0025
Mailing Address - Country:US
Mailing Address - Phone:770-227-9950
Mailing Address - Fax:770-227-9958
Practice Address - Street 1:3223 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:770-227-9950
Practice Address - Fax:770-227-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA126030031310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility