Provider Demographics
NPI:1467930552
Name:BRISTOL PALLIATIVE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:BRISTOL PALLIATIVE CARE SERVICES, LLC
Other - Org Name:BRISTOL ADVANCED ILLNESS MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:573-760-3730
Mailing Address - Street 1:206 N 2100 W STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4741
Mailing Address - Country:US
Mailing Address - Phone:801-325-0175
Mailing Address - Fax:801-478-3588
Practice Address - Street 1:206 N 2100 W STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-4741
Practice Address - Country:US
Practice Address - Phone:801-325-0175
Practice Address - Fax:801-478-3588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty