Organization Active NPI

Mid-Delta Hospice North Inc

Doing business as Bristol Hospice - Southaven

  • Community Based Hospice Care Agency
  • Southaven, MS
National Provider Identifier
1184687725
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
111 Issued in MS
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, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

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)CodeLicenseStatePrimary
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 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
CorporationProprietary
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 - SouthavenCCN 251620 · All quality measures
Ownership
For-Profit
Certified
Nov 14, 2005
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1047042Mid-Delta Hospice North Inc617 N State St, Clarksdale, MS 38614Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory

Locations

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.

NameRoleSinceShare
Roderick C Givens Individual Contracted Managing EmployeeMD; Jun 20, 2024
Bristol Hospice Holdings Inc Organization, Salt Lake City, UT Corporation, Holding company 5% Or Greater Indirect Ownership Interest Jun 20, 2024 100%
Alex Edward Mauricio Individual Corporate OfficerPresident and Ceo Jun 20, 2024 100%
Webster Equity Partners Bristol CF LP Organization, Waltham, MA Investment firm 5% Or Greater Indirect Ownership Interest Jun 20, 2024 76.82%
John Charles Garbarino Individual Corporate OfficerSecre Jun 20, 2024 100%
Jami Canady Individual W-2 Managing EmployeeAd;Rvpo Jun 20, 2024
Webster Equity Partners IV Bristol CF LP Organization, Waltham, MA 5% Or Greater Indirect Ownership Interest Jun 20, 2024 6.43%
Michael Derrick Individual Corporate OfficerCfo Jun 20, 2024 100%
Bristol Ultimate Holdco, LP Organization, Salt Lake City, UT Holding company 5% Or Greater Indirect Ownership Interest Jun 20, 2024 100%
Bristol Hospice, L.L.C. Organization, Salt Lake City, UT LLC, For-profit, Chain home office 5% Or Greater Direct Ownership Interest Jun 20, 2024 100%
Bristol Hospice Topco Inc Organization, Salt Lake City, UT Corporation, Holding company 5% Or Greater Indirect Ownership Interest Jun 20, 2024 100%
David a Malm Individual Corporate OfficerVice President 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.

Facilities with the same owner 52

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 52

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

Sources for this page

Verify at the official NPI Registry.