Active NPI
Bristol Hospice - Bangor, LLC
- Community Based Hospice Care Agency
- Bangor, ME
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- BRISTOL HOSPICE - BANGOR, LLC
- Practice address
- 824 Stillwater Ave Ste B
Bangor, ME 04401-3614 - Phone
- (207) 605-9620
- Fax
- (207) 531-3438
- NPI assigned
- Dec 8, 2023
- Last updated
- Jul 1, 2024
- 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
- President/Ceo
- Phone
- (801) 325-0175
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
824 Stillwater Ave Ste B
Bangor, ME 04401-3614
Mailing address
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 ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240711002304 | ME | Part A Provider - Hospice | 7810432077 | Practice locations: Bangor, ME |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1336916469. Details of each certification follow.
Hospice certification: CCN 201526
- Legal name
- BRISTOL HOSPICE - BANGOR, LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 30, 2024
- Last certification
- Oct 30, 2024
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC
- Incorporated
- Oct 25, 2023 in DE
- Enrollment address
- 824 Stillwater Ave
Ste B
Bangor, ME 04401-3614
Care Compare: Hospice
Medicare Care Compare- Listed as
- Bristol Hospice - Bangor LLC
- Certified
- Oct 30, 2024
- 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 |
|---|---|---|---|
| 20D2306044 | Bristol Hospice - Bangor, LLC | Certificate of waiver | Jun 10, 2028 |
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Bristol Hospice Holdings Inc | 5% Or Greater Indirect Ownership Interest | May 15, 2024 | 100% |
| Alex Edward Mauricio | Corporate Officer | May 15, 2024 | |
| Corporate Director | May 15, 2024 | ||
| Webster Equity Partners Bristol CF LP | 5% Or Greater Indirect Ownership Interest | May 15, 2024 | 69.8% |
| John Charles Garbarino | Corporate Officer | May 15, 2024 | |
| Corporate Director | May 15, 2024 | ||
| Laura L Matones | Contracted Managing Employee | Jun 24, 2024 | |
| Webster Equity Partners IV Bristol CF LP | 5% Or Greater Indirect Ownership Interest | May 15, 2024 | 5.72% |
| Michael Derrick | Corporate Officer | May 15, 2024 | |
| Erica Lilly | W-2 Managing Employee | May 15, 2024 | |
| Betty J Brennan | Corporate Director | Jul 13, 2018 | |
| Bristol Ultimate Holdco, LP | 5% Or Greater Indirect Ownership Interest | May 15, 2024 | 100% |
| Hyrum Kirton | Corporate Director | Oct 26, 2020 | |
| Aware Super Pty, LTD. | 5% Or Greater Indirect Ownership Interest | Jan 24, 2022 | 8.28% |
| Bristol Hospice, L.L.C. | 5% Or Greater Direct Ownership Interest | May 15, 2024 | 100% |
| Bristol Hospice Topco Inc | 5% Or Greater Indirect Ownership Interest | May 15, 2024 | 100% |
| David a Malm | Corporate Officer | May 15, 2024 | |
| Corporate Director | May 15, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Bangor, ME
- NPI 1760450829
Contracted Managing Employee
Facilities with the same owner 52
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Community Based Hospice Care Agency
- Bend, OR
- NPI 1356916845
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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
Aware Super Pty, LTD., 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 All Saints Hospice, Inc.
- Community Based Hospice Care Agency
- Ontario, CA
- NPI 1013318112
Aware Super Pty, LTD., 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
- Madison, WI
- NPI 1992382733
Aware Super Pty, LTD., 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 16
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": "1701993600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1719792000000",
"number": "1336916469",
"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": "824 STILLWATER AVE STE B",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013614",
"telephone_number": "207-605-9620",
"fax_number": "207-531-3438"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRISTOL HOSPICE - BANGOR, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-12-08",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A",
"authorized_official_last_name": "MAURICIO",
"authorized_official_first_name": "ALEX",
"authorized_official_title_or_position": "PRESIDENT/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 Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.