Healthcare Provider Details

I. General information

NPI: 1023028107
Provider Name (Legal Business Name): BON SECOURS DEPAUL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KINGSLEY LN
NORFOLK VA
23505-4602
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-3200
  • Fax: 757-889-3288
Mailing address:
  • Phone: 804-627-5573
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH 1829
License Number StateVA

VIII. Authorized Official

Name: KAREN REICH
Title or Position: CEO
Credential:
Phone: 727-568-1016