Healthcare Provider Details

I. General information

NPI: 1740191766
Provider Name (Legal Business Name): BRISTOL HOSPICE - CHICAGO, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W JACKSON ST STE 230
JOLIET IL
60432-1729
US

IV. Provider business mailing address

206 N 2100 W STE 202
SALT LAKE CITY UT
84116-4741
US

V. Phone/Fax

Practice location:
  • Phone: 815-296-5150
  • Fax: 815-620-3002
Mailing address:
  • Phone: 801-325-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEX MAURICIO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 801-325-0175