Provider Demographics
NPI:1891842308
Name:BON SECOURS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BON SECOURS COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-368-5000
Mailing Address - Street 1:160 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2114
Mailing Address - Country:US
Mailing Address - Phone:845-858-7000
Mailing Address - Fax:845-858-7415
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2114
Practice Address - Country:US
Practice Address - Phone:845-858-7000
Practice Address - Fax:845-858-7415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33S135Medicare Oscar/Certification