Provider Demographics
NPI:1043700347
Name:CHESAPEAKE HOSPITAL LLC
Entity Type:Organization
Organization Name:CHESAPEAKE HOSPITAL LLC
Other - Org Name:BON SECOURS LIVELY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-627-5573
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:36 LIVELY OAKS RD
Practice Address - Street 2:
Practice Address - City:LIVELY
Practice Address - State:VA
Practice Address - Zip Code:22507
Practice Address - Country:US
Practice Address - Phone:804-462-5155
Practice Address - Fax:804-462-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty