Provider Demographics
NPI:1497983407
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 ST. PETERSBURG HOME CARE 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 1:137 S PEBBLE BEACH BLVD
Practice Address - Street 2:STE 203
Practice Address - City:SUN CITY
Practice Address - State:FL
Practice Address - Zip Code:22573-5708
Practice Address - Country:US
Practice Address - Phone:813-443-5566
Practice Address - Fax:813-374-6997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS ST. PETERSBURG HOME CARE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health