Healthcare Provider Details

I. General information

NPI: 1275023707
Provider Name (Legal Business Name): CHESAPEAKE HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 NORTHUMBERLAND HWY
HEATHSVILLE VA
22473-3309
US

IV. Provider business mailing address

PO BOX 639991
CINCINNATI OH
45263-9991
US

V. Phone/Fax

Practice location:
  • Phone: 804-580-7200
  • Fax: 804-580-7063
Mailing address:
  • Phone: 804-627-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY RALSTON
Title or Position: SYSTEM DIRECTOR
Credential:
Phone: 419-996-5119