Healthcare Provider Details

I. General information

NPI: 1780689265
Provider Name (Legal Business Name): BRISTOL HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LANCASTER ST
BRISTOL VA
24201-4135
US

IV. Provider business mailing address

29 LANCASTER ST
BRISTOL VA
24201-4135
US

V. Phone/Fax

Practice location:
  • Phone: 276-466-4939
  • Fax: 276-466-2278
Mailing address:
  • Phone: 276-466-4939
  • Fax: 276-466-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03641263
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number497439
License Number StateVA

VIII. Authorized Official

Name: MRS. PAMELA MICHELLE FANSLER
Title or Position: PRESIDENT ADMINISTRATOR
Credential: RN
Phone: 276-466-4939