1164527792 NPI number — BRISTOL HOSPICE - UTAH, L.L.C.

Table of content: (NPI 1164527792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164527792 NPI number — BRISTOL HOSPICE - UTAH, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL HOSPICE - UTAH, L.L.C.
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:
1164527792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 E 400 S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84111-2846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-325-0146
Provider Business Mailing Address Fax Number:
801-596-9001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1638 N WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84404-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-924-0867
Provider Business Practice Location Address Fax Number:
801-747-3864
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRTON
Authorized Official First Name:
HYRUM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
801-325-0175

Provider Taxonomy Codes

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

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

  • Identifier: 1164527792 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".