Provider Demographics
NPI:1215333703
Name:BRISTOL ENTERPRISES BAY AREA INC.
Entity type:Organization
Organization Name:BRISTOL ENTERPRISES BAY AREA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-861-2000
Mailing Address - Street 1:2390 EASTEX FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-4638
Mailing Address - Country:US
Mailing Address - Phone:409-861-2000
Mailing Address - Fax:409-861-2002
Practice Address - Street 1:17043 EL CAMINO REAL
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2653
Practice Address - Country:US
Practice Address - Phone:409-861-2000
Practice Address - Fax:409-861-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care