NPIMap

Organization Active NPI

Lightbridge Hospice, LLC

  • Community Based Hospice Care Agency
  • San Diego, CA
National Provider Identifier
1154320299
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
080000772 Issued in CA
Legal business name
LIGHTBRIDGE HOSPICE, LLC
Practice address
6155 Cornerstone Court East
Suite 220
San Diego, CA 92121-4737
Phone
(858) 458-2992
Fax
(858) 458-3655
NPI assigned
Jul 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jill Mendlen, CEO
Title
Ceo
Phone
(858) 458-2992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 080000772 CA Primary

Addresses

Primary practice location

6155 Cornerstone Court East
Suite 220
San Diego, CA 92121-4737

Mailing address

6155 Cornerstone CT E
Suite 220
San Diego, CA 92121-4737
Phone (858) 458-2992

Other identifiers 1

IdentifierTypeStateIssuer
HPC01763FMedicaidCA

Other names 1

  • LIGHTBRIDGE HOSPICE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030324000034 CA Part A Provider - Hospice 2163331364 Practice locations: San Diego, CA

Hospice certification: CCN 051763

Legal name
LIGHTBRIDGE HOSPICE, LLC
Doing business as
LIGHBRIDGE HOSPICE & PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 6, 2003
Last certification
Sep 28, 2018
Ownership / control type
Proprietary - Partnership
Organization structure
LLCProprietary
Incorporated
Dec 17, 2002 in CA
Enrollment address
6155 Cornerstone CT E
Ste 220
San Diego, CA 92121-4737

Care Compare: Hospice

Medicare Care Compare
Listed as
Lightbridge HospiceCCN 051763
Ownership
For-Profit
Certified
Aug 6, 2003
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

5055 Avenida Encinas
Ste 210
Carlsbad, CA 92008
Phone (760) 438-8883

5280 Carroll Canyon Rd
Ste 310
San Diego, CA 92121
Phone (858) 458-2992

6155 Cornerstone Ct E
Ste 220
San Diego, CA 92121
Phone (858) 458-2992

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Emmet W Lee Individual Contracted Managing EmployeeMD; Sep 1, 2007
Louis Eisenberg Investment Trust Organization, Farmington Hills, MI 5% Or Greater Direct Ownership Interest Jan 1, 2022 5.56%
Anna Eisenberg Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2022 5.05%
Eisenberg 2002 Family LLC Organization, Farmington Hills, MI LLC 5% Or Greater Direct Ownership Interest Dec 17, 2002 15.36%
Anna Eisenberg Investment Trust Organization, Farmington Hills, MI 5% Or Greater Direct Ownership Interest Jan 1, 2022 5.05%
Sandra Bonet Individual Other Dec 17, 2002 2.85%
Sandra Bonet Trust Organization, North Bergen, NJ Other Dec 17, 2002 2.85%
Maxwell Eisenberg Investment Trust Organization, Farmington Hills, MI Other Jan 1, 2022 4.74%
Angelina Winslettt Individual W-2 Managing EmployeeDirector of Patient Care Services Jun 8, 2026
Pamela Hough Individual 5% Or Greater Direct Ownership Interest Nov 1, 2022 5%
Corporate OfficerChief Operations Officer Jan 1, 2020
W-2 Managing EmployeeAd; Jan 1, 2003
Operational/Managerial ControlCoo, Administrator Jan 1, 2003
Louis Eisenberg Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2022 5.56%
Frank M Wronski Living Trust Organization, Rochester Hills, MI 5% Or Greater Direct Ownership Interest Dec 17, 2002 30.72%
Alicia Mertz Individual W-2 Managing EmployeeController, Director of Accounting Jan 13, 2014
Robin Eisenberg Individual 5% Or Greater Indirect Ownership Interest Dec 17, 2002 7.68%
Jill Mendlen Individual 5% Or Greater Indirect Ownership Interest Dec 17, 2002 15.36%
Corporate OfficerCeo / President Jan 1, 2003
W-2 Managing EmployeeCeo / President Dec 17, 2002
Operational/Managerial ControlCeo / President Jan 1, 2003
Leo Eisenberg Individual 5% Or Greater Indirect Ownership Interest Dec 17, 2002 7.68%
Corporate Officer Apr 8, 2003
Richard Mendlen Individual 5% Or Greater Indirect Ownership Interest Dec 17, 2002 15.36%
Frank M Wronski Individual 5% Or Greater Indirect Ownership Interest Dec 17, 2002 30.72%
Corporate Officer Apr 8, 2003
Maxwell Eisenberg Individual Other Jan 1, 2022 4.74%
Mendlen Family Trust Organization, El Cajon, CA 5% Or Greater Direct Ownership Interest Dec 17, 2002 30.72%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1154320299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6155 CORNERSTONE CT E",
            "address_2": "SUITE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214737",
            "telephone_number": "858-458-2992",
            "fax_number": "858-458-3655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6155 CORNERSTONE COURT EAST",
            "address_2": "SUITE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214737",
            "telephone_number": "858-458-2992",
            "fax_number": "858-458-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTBRIDGE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "MENDLEN",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "858-458-2992",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "080000772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HPC01763F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIGHTBRIDGE HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.