NPIMap

Organization Active NPI

Lifebrite Hospital Group of Stokes, LLC

  • Rural Health Clinic/Center
  • Danbury, NC
National Provider Identifier
1609319490
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
Practice address
1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone
(336) 593-8281
Fax
(336) 593-5282
NPI assigned
Nov 28, 2016
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Christian Fletcher
Title
Ceo
Phone
(336) 593-5311

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Facilities with the same owner 4

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

Practitioners 10

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170208002332 NC Part A Provider - Rural Health Clinic 8921380759 Practice locations: Danbury, NC
O20170220001211 NC Part B Supplier - Clinic/Group Practice 8921380759 Receives reassigned benefits from 29 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King, NC; Pine Hall, NC; Danbury, NC

Rural health clinic certification: CCN 343447

Legal name
LIFEBRITE HOSPITAL GROUP OF STOKES LLC
Doing business as
LIFEBRITE FAMILY MEDICAL OF DANBURY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 28, 2012
Last certification
Feb 10, 2025
Ownership / control type
1B
Most recent change of ownership
Jan 30, 2017 (1 total)
Organization structure
LLCProprietary
Incorporated
Oct 12, 2016 in GA
Enrollment address
1570 NC 8 & 89 Hwy North
Danbury, NC 27016-7360
Related CCNs
341317

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 7

Medicare enrollment files

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

NameRoleSinceShare
Lifebrite Hospital Group LLC Organization, Brookhaven, GA LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 12, 2016 100%
Operational/Managerial Control Oct 12, 2016
Christian Fletcher Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 46%
Corporate OfficerCeo Jan 30, 2017
Operational/Managerial ControlCeo Jan 30, 2017
Pamela Tillman Individual W-2 Managing EmployeeAdministrator Jan 30, 2017
Amber D Fletcher Individual Corporate OfficerCoo Jan 30, 2017
Operational/Managerial ControlCoo Jan 30, 2017
Fletcher 2018 Family Trust Organization, Atlanta, GA 5% Or Greater Indirect Ownership Interest Dec 28, 2018 49%
Amber Dominique Fletcher 2018 Trust Organization, Atlanta, GA 5% Or Greater Indirect Ownership Interest Dec 28, 2018 5%
Lifebrite Laboratories, LLC Organization, Brookhaven, GA LLC, For-profit 5% Or Greater Indirect Ownership Interest Jan 30, 2017 100%

Change-of-ownership history 1

Medicare enrollment files
DateEventCounterparty
Jan 30, 2017 Change of OwnershipThis provider was the buyer Pioneer Family Medical of DanburyCCN 343447, NC, NPI 1912294687

National Provider Directory

National Provider Directory
Tax ID family
Lifebrite Hospital Group of10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360

Mailing address

1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone (336) 593-5311

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
G557OtherNCMEDICARE PART B PTAN
343447OtherNCPTAN
H0165OtherNCHOSPITAL LICENSURE

Other names 1

NPPES NPI Registry
  • LifeBrite Family Medical of Danbury Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 2, 2021.

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1609319490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 NC 8 AND 89 HWY N",
            "city": "DANBURY",
            "state": "NC",
            "postal_code": "270167360",
            "telephone_number": "336-593-5311",
            "fax_number": "336-593-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 NC 8 AND 89 HWY N",
            "city": "DANBURY",
            "state": "NC",
            "postal_code": "270167360",
            "telephone_number": "336-593-8281",
            "fax_number": "336-593-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRITE HOSPITAL GROUP OF STOKES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-593-5311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "G557",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "343447",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSURE",
            "identifier": "H0165",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBrite Family Medical of Danbury",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LifeBrite Family Medical of Danbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danbury, NC

Sources for this page

Verify at the official NPI Registry.