MEDICARE: BRISTOL ELDER SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255468963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTOL ELDER SERVICES, INC.

Provider Business Mailing Address
First Line	:	1 FATHER DEVALLES BLVD STE 101
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1511
Country	:	US
Telephone Number	:	508-675-2101
Fax Number	:	508-679-0320

Provider Business Practice Location Address
First Line	:	1 FATHER DEVALLES BLVD STE 101
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02723-1511
Country	:	US
Telephone Number	:	508-675-2101
Fax Number	:	508-679-0320

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MS. DENISE DOMIN
Credential	:
Telephone Number	:	508-675-2101

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/29/2008

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