Provider Demographics
NPI:1568962033
Name:BRISTOL HOSPICE - EUGENE, LLC
Entity Type:Organization
Organization Name:BRISTOL HOSPICE - EUGENE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
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 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:801-656-2769
Mailing Address - Fax:801-478-3588
Practice Address - Street 1:400 INTERNATIONAL WAY STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7004
Practice Address - Country:US
Practice Address - Phone:541-844-0151
Practice Address - Fax:541-636-2722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based