Organization Active NPI

Bristol Hospice - Richmond, L.L.C.

  • Community Based Hospice Care Agency
  • Richmond, VA
National Provider Identifier
1225774136
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BRISTOL HOSPICE - RICHMOND, L.L.C.
Practice address
7400 Beaufont Springs Dr.
Ste 105
Richmond, VA 23225-5519
Phone
(804) 554-5530
Fax
(804) 552-6024
NPI assigned
May 12, 2022
Organization subpart
Yes
Parent organization
BRISTOL HOSPICE, L.L.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alex Mauricio
Title
President and Ceo
Phone
(801) 325-0175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

7400 Beaufont Springs Dr.
Ste 105
Richmond, VA 23225-5519

Mailing address

206 N 2100 W Ste 202
Salt Lake City, UT 84116-4741
Phone (801) 325-0175

Other practice location 1

206 N 2100 W Ste 202
Salt Lake City, UT 84116-4741
Phone (801) 325-0175

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230322001105 VA Part A Provider - Hospice 6305210980 Practice locations: Richmond, VA

Hospice certification: CCN 491655

Legal name
BRISTOL HOSPICE - RICHMOND, L.L.C.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 14, 2023
Last certification
Jun 2, 2023
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
May 9, 2022 in VA
Enrollment address
7400 Beaufont Springs Dr
Ste 105
Richmond, VA 23225-5519

Care Compare: Hospice

Medicare Care Compare
Listed as
Bristol Hospice - Richmond, L.L.C.CCN 491655
Certified
Jun 14, 2023
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
49D2273930Bristol Hospice-Richmond, LLC7400 Beaufont Springs Dr, Suite 105, Richmond, VA 23225Certificate of waiverDec 20, 2026

National Provider Directory

National Provider Directory
Part of
Bristol Hospice LLC

Locations

7400 Beaufont Spring Dr
Ste 105
North Chesterfield, VA 23225
Phone (804) 554-5530

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bristol Hospice Holdings Inc Organization, Salt Lake City, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 9, 2022 100%
Alex Edward Mauricio Individual Corporate OfficerPresident and Ceo May 9, 2022
Corporate DirectorDirector May 9, 2022
Webster Equity Partners Bristol CF LP Organization, Waltham, MA For-profit, Private equity company 5% Or Greater Indirect Ownership Interest May 9, 2022 69.8%
Brett L Montgomery Individual Contracted Managing EmployeeMedical Director Dec 1, 2023
John Charles Garbarino Individual Corporate OfficerSecretary/Treasurer May 9, 2022
Corporate DirectorDirector May 9, 2022
Webster Equity Partners IV Bristol CF LP Organization, Waltham, MA For-profit, Private equity company 5% Or Greater Indirect Ownership Interest May 9, 2022 5.72%
Michael Derrick Individual Corporate OfficerCfo Sep 1, 2023
Betty J Brennan Individual Corporate DirectorDirector Jun 14, 2023
Bristol Ultimate Holdco, LP Organization, Salt Lake City, UT Holding company, For-profit, Private equity company 5% Or Greater Indirect Ownership Interest May 9, 2022 100%
Kristal M Bennett Individual W-2 Managing EmployeeAd; May 9, 2022
Hyrum Kirton Individual Corporate DirectorDirector Jun 14, 2023
Aware Super Pty, LTD. Organization, Sydney, IN Investment firm, For-profit 5% Or Greater Indirect Ownership Interest Jun 14, 2023 8.28%
Bristol Hospice, L.L.C. Organization, Salt Lake City, UT LLC, Holding company, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 9, 2022 100%
Bristol Hospice Topco Inc Organization, Salt Lake City, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 9, 2022 100%
David a Malm Individual Corporate OfficerVice President May 9, 2023
Corporate DirectorDirector May 9, 2023

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 2

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": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1225774136",
    "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",
            "fax_number": "801-478-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 BEAUFONT SPRINGS DR.",
            "address_2": "STE 105",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232255519",
            "telephone_number": "804-554-5530",
            "fax_number": "804-552-6024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "206 N 2100 W Ste 202",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841164741",
            "country_code": "US",
            "telephone_number": "801-325-0175",
            "fax_number": "801-478-3533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRISTOL HOSPICE - RICHMOND, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRISTOL HOSPICE, L.L.C.",
        "enumeration_date": "2022-05-12",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "MAURICIO",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "801-325-0175"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.