Bon Secours Maryview Nursing Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2511 Issued in VA

Legal business name

BON SECOURS MARYVIEW NURSING CARE CENTER LLC

Practice address

4775 Bridge Rd
Suffolk, VA 23435-2045

Phone

(757) 686-0488

Fax

(757) 686-8211

NPI assigned

Jul 30, 2006

Organization subpart

No

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 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1124033980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "telephone_number": "804-627-5573",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 BRIDGE RD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234352045",
            "telephone_number": "757-686-0488",
            "fax_number": "757-686-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MARYVIEW NURSING CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-10-22",
        "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "VA",
            "license": "NH2511",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4952065",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leigh-Anna Boles
• Brenda Bollenberg
• Chase Bollig, D.C.
• Taylor Anne Bollig, D.C.
• Bon Secours Maryview Nursing Care Center
• Bon Secours Medical Group Hampton Roads Specialty Care LLC
• Bon Secours Medical Group Hampton Roads Specialty Care LLC
• Bon Secours Surgery Center at Harbour View, LLC
• Brittani D Bonner, PA-C
• Towana Renee Boone, MBA-MA

• All providers in Suffolk, VA
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.