Basic Information
Provider Information
NPI: 1548703457
EntityType: 2
ReplacementNPI:  
OrganizationName: LIFEBRITE HOSPITAL GROUP OF STOKES, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: LIFEBRITE MEDICAL CENTER OF KING
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 402 W KING ST
Address2:  
City: KING
State: NC
PostalCode: 270219170
CountryCode: US
TelephoneNumber: 3369839617
FaxNumber: 3369839791
Practice Location
Address1: 402 W KING ST
Address2:  
City: KING
State: NC
PostalCode: 270219170
CountryCode: US
TelephoneNumber: 3369839617
FaxNumber: 3369839791
Other Information
ProviderEnumerationDate: 11/25/2016
LastUpdateDate: 09/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FLETCHER
AuthorizedOfficialFirstName: CHRISTIAN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 3365935311
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X  N HospitalsGeneral Acute Care HospitalCritical Access
261QC0050X  Y Ambulatory Health Care FacilitiesClinic/CenterCritical Access Hospital

ID Information
IDTypeStateIssuerDescription
G55701NCMEDICARE PART B PTANOTHER
H016501NCHOSPITAL LICENSUREOTHER


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