Provider Demographics
NPI:1568710358
Name:BRISTOL HOSPICE - PATHWAYS LLC
Entity Type:Organization
Organization Name:BRISTOL HOSPICE - PATHWAYS LLC
Other - Org Name:BRISTOL HOSPICE - NORTH CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0175
Mailing Address - Street 1:206 N 2100 W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4740
Mailing Address - Country:US
Mailing Address - Phone:801-325-0175
Mailing Address - Fax:801-478-3533
Practice Address - Street 1:1905 N HIGHWAY 77 STE 220
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7916
Practice Address - Country:US
Practice Address - Phone:972-923-2436
Practice Address - Fax:972-923-0043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025673Medicaid