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General NPI Number Information
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NPI Number | 1366424202
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Entity Type | Organization
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Legal Business Name | BON SECOURS PLACE AT ST PETERSBURG LLC
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 10401 ROOSEVELT BLVD N
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City | ST PETERSBURG
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State | FL
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Zip | 33716-3836
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Country | US
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Telephone | 727-563-9733
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Fax | 727-563-9595
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Provider Business Mailing Address
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Address Line | 10401 ROOSEVELT BLVD N
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City | ST PETERSBURG
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State | FL
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Zip | 33716-3836
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Country | US
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Telephone | 727-563-9733
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Fax | 866-449-0896
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Authorized Official
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Title or Position | CEO
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Name | KAREN G. REICH
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Credential |
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Telephone | 727-568-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 9939
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License Number State | FL
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