Healthcare Provider Details

I. General information

NPI: 1356916845
Provider Name (Legal Business Name): BRISTOL HOSPICE - BEND, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 SW 13TH ST STE 101
BEND OR
97702-3156
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: 541-550-1155
  • Fax: 541-797-6479
Mailing address:
  • Phone: 801-325-0175
  • Fax: 801-478-3533

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 AND CEO
Credential:
Phone: 801-325-0175