Active NPI
Mid-Delta Hospice North Inc
Doing business as Bristol Hospice - Southaven
- Community Based Hospice Care Agency
- Southaven, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- 111
- Legal business name
- MID-DELTA HOSPICE NORTH INC
- Doing business as
- Bristol Hospice - Southaven
- Practice address
- 230-2 Goodman Road
Suite 200
Southaven, MS 38671 - Phone
- (662) 399-2860
- Fax
- (662) 901-2048
- NPI assigned
- Apr 6, 2006
- Last updated
- Feb 19, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alex Mauricio
- Title
- Ceo/President
- Phone
- (801) 325-0175
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 111 | MS | Primary |
Addresses
Primary practice location
230-2 Goodman Road
Suite 200
Southaven, MS 38671
Mailing address
206 N 2100 W Ste 202
Salt Lake City, UT 84116-4741
Phone (801) 325-0175
Other names 1
- Bristol Hospice - Southaven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041008001360 | MS | Part A Provider - Hospice | 0941269443 | Practice locations: Clarksdale, MS |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1184687725. Details of each certification follow.
Hospice certification: CCN 251620
- Legal name
- MID-DELTA HOSPICE NORTH, INC.
- Doing business as
- BRISTOL HOSPICE - SOUTHAVEN
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 14, 2005
- Last certification
- Aug 12, 2021
- Ownership / control type
- Proprietary - Corporation
- Most recent change of ownership
- Jun 20, 2024
- Organization structure
- Corporation
- Incorporated
- Sep 29, 2004 in MS
- Enrollment address
- 617 N State St
Clarksdale, MS 38614-6517
Care Compare: Hospice
Medicare Care Compare- Listed as
- Mid Delta Hospice North, Inc Dba Bristol Hospice - Southaven
- Ownership
- For-Profit
- Certified
- Nov 14, 2005
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D1047042 | Mid-Delta Hospice North Inc | Certificate of waiver | Oct 24, 2027 |
National Provider Directory
National Provider DirectoryLocations
112 Highway 51 N
Batesville, MS 38606
Phone (662) 563-1021
200 Martin Luther King Dr
Marks, MS 38646
Phone 66232681108
Ownership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Roderick C Givens | Contracted Managing Employee | Jun 20, 2024 | |
| Bristol Hospice Holdings Inc | 5% Or Greater Indirect Ownership Interest | Jun 20, 2024 | 100% |
| Alex Edward Mauricio | Corporate Officer | Jun 20, 2024 | 100% |
| Webster Equity Partners Bristol CF LP | 5% Or Greater Indirect Ownership Interest | Jun 20, 2024 | 76.82% |
| John Charles Garbarino | Corporate Officer | Jun 20, 2024 | 100% |
| Jami Canady | W-2 Managing Employee | Jun 20, 2024 | |
| Webster Equity Partners IV Bristol CF LP | 5% Or Greater Indirect Ownership Interest | Jun 20, 2024 | 6.43% |
| Michael Derrick | Corporate Officer | Jun 20, 2024 | 100% |
| Bristol Ultimate Holdco, LP | 5% Or Greater Indirect Ownership Interest | Jun 20, 2024 | 100% |
| Bristol Hospice, L.L.C. | 5% Or Greater Direct Ownership Interest | Jun 20, 2024 | 100% |
| Bristol Hospice Topco Inc | 5% Or Greater Indirect Ownership Interest | Jun 20, 2024 | 100% |
| David a Malm | Corporate Officer | Jun 20, 2024 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Therapeutic Radiology Physician
- Natchez, MS
- NPI 1558422576
Contracted Managing Employee
Facilities with the same owner 52
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Bristol Hospice - Brookhaven
- Community Based Hospice Care Agency
- Brookhaven, MS
- NPI 1316900962
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Bangor, ME
- NPI 1336916469
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Bend, OR
- NPI 1356916845
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Plymouth Meeting, PA
- NPI 1356118467
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Merced, CA
- NPI 1487603452
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- North Charleston, SC
- NPI 1326866963
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Des Plaines, IL
- NPI 1104548478
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Springfield, OR
- NPI 1568962033
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Atlanta, GA
- NPI 1558663872
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
- Community Based Hospice Care Agency
- Green Bay, WI
- NPI 1356928154
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Healthcare Services
- Community Based Hospice Care Agency
- Honolulu, HI
- NPI 1811045594
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Inland Empire
- Community Based Hospice Care Agency
- Riverside, CA
- NPI 1043683170
Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1771459200000",
"number": "1184687725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 N 2100 W STE 202",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841164741",
"telephone_number": "801-325-0175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230-2 GOODMAN ROAD",
"address_2": "SUITE 200",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "38671",
"telephone_number": "662-399-2860",
"fax_number": "662-901-2048"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MID-DELTA HOSPICE NORTH INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-04-06",
"last_updated": "2026-02-19",
"certification_date": "2026-02-19",
"status": "A",
"authorized_official_last_name": "MAURICIO",
"authorized_official_first_name": "ALEX",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "801-325-0175"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "MS",
"license": "111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Bristol Hospice - Southaven",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Southaven, MS
- Michael E Foster MD PC
- Michael E Steuer MD PC
- Micheal G Cook OD PC (eyear optical)
- Anna Kathryn Michell, COTA/L
- Mid South Otolaryngology Associates P.C.
- Mid-South Anesthesia Consultants, PLLC
- Mid-South Imaging Center LLC
- Mid-South Orthopedic Hospitalists LLC
- Lindsey Nicole Middleton, NP
- Midsouth Hospitalists, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.