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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 1948512 | Medicaid |