Provider Demographics
NPI:1780689265
Name:BRISTOL HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BRISTOL HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:276-466-4939
Mailing Address - Street 1:29 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4135
Mailing Address - Country:US
Mailing Address - Phone:276-466-4939
Mailing Address - Fax:276-466-2278
Practice Address - Street 1:29 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4135
Practice Address - Country:US
Practice Address - Phone:276-466-4939
Practice Address - Fax:276-466-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA03641263251E00000X
VA497439251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004974395Medicaid
VA004974395Medicaid