Provider Demographics
NPI:1639469380
Name:BRISTOL HOSPICE - ROGUE VALLEY, L.L.C.
Entity type:Organization
Organization Name:BRISTOL HOSPICE - ROGUE VALLEY, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND 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 1:1867 WILLIAMS HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5854
Mailing Address - Country:US
Mailing Address - Phone:458-212-3422
Mailing Address - Fax:541-291-9806
Practice Address - Street 1:1867 WILLIAMS HWY STE 110
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5854
Practice Address - Country:US
Practice Address - Phone:582-123-4224
Practice Address - Fax:541-291-9806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based