Provider Demographics
NPI:1760879332
Name:BRISTOL VILLAGE MANAGEMENT LLC
Entity Type:Organization
Organization Name:BRISTOL VILLAGE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-207-7250
Mailing Address - Street 1:1358 MANCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3881
Mailing Address - Country:US
Mailing Address - Phone:470-207-7250
Mailing Address - Fax:470-207-7249
Practice Address - Street 1:1358 MANCHESTER DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3881
Practice Address - Country:US
Practice Address - Phone:470-207-7250
Practice Address - Fax:470-207-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)