Provider Demographics
NPI:1922120534
Name:BRISTOL HOME CARE AND HOSPICE AGENCY INC
Entity Type:Organization
Organization Name:BRISTOL HOME CARE AND HOSPICE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALFANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-585-0837
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0977
Mailing Address - Country:US
Mailing Address - Phone:860-585-4752
Mailing Address - Fax:860-585-1756
Practice Address - Street 1:32 VALLEY ST STE D
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4991
Practice Address - Country:US
Practice Address - Phone:860-585-0837
Practice Address - Fax:860-585-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07.1517251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004132958Medicaid