Provider Demographics
NPI:1477875128
Name:BON SECOURS HOME CARE LLC
Entity Type:Organization
Organization Name:BON SECOURS HOME CARE LLC
Other - Org Name:BON SECOURS HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP 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:PO BOX 631115
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1115
Mailing Address - Country:US
Mailing Address - Phone:513-952-5002
Mailing Address - Fax:
Practice Address - Street 1:2603 NINE MILE RD
Practice Address - Street 2:STE 220
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223
Practice Address - Country:US
Practice Address - Phone:805-627-5360
Practice Address - Fax:804-627-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHSP-1006251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004910281Medicaid
VA491514Medicare Oscar/Certification