Provider Demographics
NPI:1679306880
Name:BRIGHTON HOSPICE GRAND RAPIDS LLC
Entity type:Organization
Organization Name:BRIGHTON HOSPICE GRAND RAPIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-996-3217
Mailing Address - Street 1:9800 S MONROE ST STE 900
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4419
Mailing Address - Country:US
Mailing Address - Phone:801-996-3217
Mailing Address - Fax:
Practice Address - Street 1:3033 ORCHARD VISTA DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7077
Practice Address - Country:US
Practice Address - Phone:801-996-3217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based