Healthcare Provider Details

I. General information

NPI: 1366424202
Provider Name (Legal Business Name): BON SECOURS PLACE AT ST PETERSBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 ROOSEVELT BLVD N
ST PETERSBURG FL
33716-3836
US

IV. Provider business mailing address

10401 ROOSEVELT BLVD N
ST PETERSBURG FL
33716-3836
US

V. Phone/Fax

Practice location:
  • Phone: 727-563-9733
  • Fax: 727-563-9595
Mailing address:
  • Phone: 727-563-9733
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9939
License Number StateFL

VIII. Authorized Official

Name: KAREN G. REICH
Title or Position: CEO
Credential:
Phone: 727-568-1000