Provider Demographics
NPI:1295847341
Name:BON SECOURS ST PETERSBURG HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:BON SECOURS ST PETERSBURG HOME CARE SERVICES LLC
Other - Org Name:BON SECOURS HOMECARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REIMBURSEMENT
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 631118
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1118
Mailing Address - Country:US
Mailing Address - Phone:513-952-5002
Mailing Address - Fax:
Practice Address - Street 1:11001 ROOSEVELT BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2344
Practice Address - Country:US
Practice Address - Phone:727-577-7990
Practice Address - Fax:727-576-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992508OtherHOME HEALTH LICENSE
FL2999992508OtherHOME HEALTH LICENSE
FL108384Medicare Oscar/Certification