Active NPI
Mary Immaculate Nursing Center LLC
- Skilled Nursing Facility
- Newport News, VA
National Provider Identifier
1225075294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH2695
- Legal business name
- MARY IMMACULATE NURSING CENTER LLC
- Practice address
- 4 Ridgewood Pkwy
Newport News, VA 23602-4415 - Phone
- (757) 886-6500
- Fax
- (757) 886-6539
- NPI assigned
- May 31, 2006
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH2695 | VA | Primary |
Addresses
Primary practice location
4 Ridgewood Pkwy
Newport News, VA 23602-4415
Mailing address
8580 Magellan Pkwy
Richmond, VA 23227-1149
Phone (804) 627-5573
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4952049 | Medicaid | VA | |
| 227691 | Other | VA | ANTHEM PROVIDER NUMBER |
| 004952049 | Medicaid | VA |
Other names 1
- Saint Francis Nursing Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603324800000",
"number": "1225075294",
"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": "4 RIDGEWOOD PKWY",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236024415",
"telephone_number": "757-886-6500",
"fax_number": "757-886-6539"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARY IMMACULATE NURSING CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-31",
"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": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "VA",
"license": "NH2695",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4952049",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "227691",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004952049",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Saint Francis Nursing Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Saint Francis Nursing Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Newport News, VA
Sources for this page
- 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.