Provider Demographics
NPI:1639430093
Name:BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Entity Type:Organization
Organization Name:BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Other - Org Name:BON SECOURS BEHAVIORAL HEALTH GROUP AT ST. MARY'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CORPORATE RESPONSIBILTY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-0271
Mailing Address - Street 1:5855 BREMO RD STE 404
Mailing Address - Street 2:MOB NORTH
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1924
Mailing Address - Country:US
Mailing Address - Phone:804-287-7788
Mailing Address - Fax:804-287-7525
Practice Address - Street 1:5855 BREMO RD STE 404
Practice Address - Street 2:MOB NORTH
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1924
Practice Address - Country:US
Practice Address - Phone:804-287-7788
Practice Address - Fax:804-287-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN