Provider Demographics
NPI:1619253606
Name:BRISTOL HOSPICE - UTAH II, L.L.C.
Entity Type:Organization
Organization Name:BRISTOL HOSPICE - UTAH II, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-433-0932
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:
Practice Address - Street 1:1106 E 6600 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-2446
Practice Address - Country:US
Practice Address - Phone:801-930-5266
Practice Address - Fax:801-930-5272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-23
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1619253606Medicaid