Bon Secours - Maria Manor Nursing Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1055096 Issued in FL

Legal business name

BON SECOURS - MARIA MANOR NURSING CARE CENTER LLC

Practice address

10300 4TH St North
St Petersburg, FL 33716-3810

Phone

(727) 568-1000

Fax

(727) 568-1088

NPI assigned

Oct 3, 2005

Last updated

Nov 3, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

BON SECOURS HEALTH SYSTEMS, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Ralston

Title

System Director

Phone

(419) 996-5119

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1013904234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 4TH ST NORTH",
            "city": "ST. PETERSBURG",
            "state": "FL",
            "postal_code": "337163810",
            "telephone_number": "727-568-1000",
            "fax_number": "727-568-1088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 4TH ST NORTH",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337163810",
            "telephone_number": "727-568-1000",
            "fax_number": "727-568-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS - MARIA MANOR NURSING CARE CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS HEALTH SYSTEMS, INC.",
        "enumeration_date": "2005-10-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1055096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020010700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sandra Lynn Bond

• Skilled Nursing Facility in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.