Healthcare Provider Details

I. General information

NPI: 1174520977
Provider Name (Legal Business Name): BRISTOL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
BRISTOL CT
06010-4923
US

IV. Provider business mailing address

400 N MAIN ST
BRISTOL CT
06010-4923
US

V. Phone/Fax

Practice location:
  • Phone: 860-584-3410
  • Fax: 860-589-8686
Mailing address:
  • Phone: 860-584-3410
  • Fax: 860-589-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2056-C
License Number StateCT

VIII. Authorized Official

Name: ASHLEY SOYKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-584-3411