Healthcare Provider Details

I. General information

NPI: 1649386244
Provider Name (Legal Business Name): BON SECOURS PRIVATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 GLENROCK RD STE 155
NORFOLK VA
23502-3718
US

IV. Provider business mailing address

3636 HIGH ST
PORTSMOUTH VA
23707-3236
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-4662
  • Fax: 757-213-7945
Mailing address:
  • Phone: 757-889-4662
  • Fax: 757-213-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number010075661
License Number StateVA

VIII. Authorized Official

Name: BARBARA G BALLARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-213-7907