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General NPI Number Information
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NPI Number | 1649386244
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Entity Type | Organization
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Legal Business Name | BON SECOURS PRIVATE CARE
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 861 GLENROCK RD STE 155
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City | NORFOLK
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State | VA
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Zip | 23502-3718
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Country | US
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Telephone | 757-889-4662
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Fax | 757-213-7945
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Provider Business Mailing Address
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Address Line | 3636 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3236
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Country | US
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Telephone | 757-889-4662
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Fax | 757-213-7945
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BARBARA G BALLARD
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Credential |
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Telephone | 757-213-7907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 010075661
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License Number State | VA
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