1922120534 NPI number — BRISTOL HOME CARE AND HOSPICE AGENCY INC

Table of content: (NPI 1922120534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922120534 NPI number — BRISTOL HOME CARE AND HOSPICE AGENCY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL HOME CARE AND HOSPICE AGENCY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922120534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06011-0977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-585-4752
Provider Business Mailing Address Fax Number:
860-585-1756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 VALLEY ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06010-4991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-585-0837
Provider Business Practice Location Address Fax Number:
860-585-1756
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHALFANT
Authorized Official First Name:
CAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLINICAL OPERATIONS
Authorized Official Telephone Number:
860-585-0837

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  07.1517 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004132958 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".