Provider Demographics
NPI:1386087609
Name:BRISTOL HOSPICE-EAST BAY, LLC
Entity type:Organization
Organization Name:BRISTOL HOSPICE-EAST BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HYRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-656-2769
Mailing Address - Street 1:206 N 2100 W
Mailing Address - Street 2:202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4740
Mailing Address - Country:US
Mailing Address - Phone:801-325-0175
Mailing Address - Fax:801-478-3568
Practice Address - Street 1:5820 STONERIDGE MALL RD STE 209
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3200
Practice Address - Country:US
Practice Address - Phone:925-400-9530
Practice Address - Fax:415-651-4996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL HOSPICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based