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NPI Code Detail

MEDICARE: BRISTOL HOSPICE - FAIRFAX, LLC

MEDICARE: BRISTOL HOSPICE - FAIRFAX, 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
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1689538787
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRISTOL HOSPICE - FAIRFAX, 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 : 12011 ROUTE 50 STE 510
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-3315
Country : US
Telephone Number : 703-977-9005
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : ALEX MAURICIO
Credential :
Telephone Number : 801-325-0175
Provider Enumeration Date : 12/12/2025
Last Update Date : 12/12/2025

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Directions to “BRISTOL HOSPICE - FAIRFAX, LLC ” Practice Location

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