NPIMap

Organization Active NPI

Brightmoor Hospice, LLC

  • Community Based Hospice Care Agency
  • Griffin, GA
National Provider Identifier
1275520751
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
111618 Issued in GA
Legal business name
BRIGHTMOOR HOSPICE, LLC
Practice address
3247 Newnan Rd
Griffin, GA 30223-7114
Phone
(770) 467-9930
Fax
(770) 467-9932
NPI assigned
Sep 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Willam C Brown
Title
Ceo
Phone
(678) 972-1642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 111618 GA Primary

Addresses

Primary practice location

3247 Newnan Rd
Griffin, GA 30223-7114

Mailing address

3247 Newnan Rd
Griffin, GA 30223-7114
Phone (770) 467-9930

Other identifiers 1

IdentifierTypeStateIssuer
000140412BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050815000143 GA Part A Provider - Hospice 7517997141 Practice locations: Griffin, GA; Macon, GA
O20210316001311 GA Part B Supplier - Clinic/Group Practice 7517997141 Receives reassigned benefits from 10 practitioners
Practice locations: Griffin, GA

Hospice certification: CCN 111618

Legal name
BRIGHTMOOR HOSPICE LLC
Doing business as
BRIGHTMOOR HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 2, 2005
Last certification
Jun 23, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Feb 6, 2004 in GA
Enrollment address
3247 Newnan Rd
Griffin, GA 30223-7114

Care Compare: Hospice

Medicare Care Compare
Listed as
Brightmoor Hospice, LLCCCN 111618
Ownership
For-Profit
Certified
Jun 2, 2005
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1033014Brightmoor Hospice Incorporated3247 Newnan Road, Griffin, GA 30223Certificate of waiverNov 2, 2026

National Provider Directory

National Provider Directory

Locations

3223 Newnan Rd
Griffin, GA 30223
Phone (770) 227-9950

115 Arkwright Lndg
Macon, GA 31210
Phone (404) 493-4718

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Donna McNeal Individual W-2 Managing EmployeeFinance Manager Sep 7, 2019 100%
Brightmoor Hospice LLC Organization, Griffin, GA LLC Operational/Managerial Control Jun 1, 2017 100%
William C Brown Individual Corporate DirectorCeo/Administrator Jun 1, 2017 100%
W-2 Managing EmployeeCeo/Administrator Jun 1, 2017 100%

Practitioners & affiliated clinicians

Practitioners 10

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

Affiliated clinicians 7

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": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1275520751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3247 NEWNAN RD",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302237114",
            "telephone_number": "770-467-9930",
            "fax_number": "770-467-9932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3247 NEWNAN RD",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302237114",
            "telephone_number": "770-467-9930",
            "fax_number": "770-467-9932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTMOOR HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "WILLAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-972-1642"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "111618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000140412B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Griffin, GA

Sources for this page

Verify at the official NPI Registry.