Healthcare Provider Details

I. General information

NPI: 1689538787
Provider Name (Legal Business Name): BRISTOL HOSPICE - FAIRFAX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 ROUTE 50 STE 510
FAIRFAX VA
22033-3315
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: 703-977-9005
  • Fax:
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