Provider Demographics
NPI:1184687790
Name:BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Entity Type:Organization
Organization Name:BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Other - Org Name:BON SECOURS ST. MARY'S HOSPITAL OF RICHMOND PSYCHIATRIC UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:PO BOX 639994
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9994
Mailing Address - Country:US
Mailing Address - Phone:804-627-5462
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-287-7836
Practice Address - Fax:804-281-8557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURSST. MARY'S HOSPITAL OF RICHMOND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1723273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4900596Medicaid
VA49S059Medicare Oscar/Certification