Healthcare Provider Details

I. General information

NPI: 1922018092
Provider Name (Legal Business Name): MARYVIEW HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 HIGH ST
PORTSMOUTH VA
23707-3236
US

IV. Provider business mailing address

PO BOX 639898
CINCINNATI OH
45263-9898
US

V. Phone/Fax

Practice location:
  • Phone: 757-398-4160
  • Fax: 757-393-1437
Mailing address:
  • Phone: 513-952-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberH 1830
License Number StateVA

VIII. Authorized Official

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