Provider Demographics
NPI:1255468963
Name:BRISTOL ELDER SERVICES, INC.
Entity Type:Organization
Organization Name:BRISTOL ELDER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-2101
Mailing Address - Street 1:1 FATHER DEVALLES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1511
Mailing Address - Country:US
Mailing Address - Phone:508-675-2101
Mailing Address - Fax:508-679-0320
Practice Address - Street 1:1 FATHER DEVALLES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1511
Practice Address - Country:US
Practice Address - Phone:508-675-2101
Practice Address - Fax:508-679-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1948512Medicaid