MEDICARE: BRISTOL HOSPICE - OHIO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1174471445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTOL HOSPICE - OHIO, LLC

Provider Business Mailing Address
First Line	:	206 N 2100 W STE 202
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-4741
Country	:	US
Telephone Number	:	801-325-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 CORPORATE EXCHANGE DR STE 175
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-7671
Country	:	US
Telephone Number	:	614-689-0240
Fax Number	:	614-298-4089

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	ALEX MAURICIO
Credential	:
Telephone Number	:	801-325-0175

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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