Provider Demographics
NPI:1720261381
Name:BON SECOURS MARYVIEW NURSING CARE CENTER
Entity type:Organization
Organization Name:BON SECOURS MARYVIEW NURSING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHHEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-889-2559
Mailing Address - Street 1:4775 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2045
Mailing Address - Country:US
Mailing Address - Phone:757-686-0488
Mailing Address - Fax:757-686-8211
Practice Address - Street 1:4775 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2045
Practice Address - Country:US
Practice Address - Phone:757-686-0488
Practice Address - Fax:757-686-8211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYVIEW HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2511313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0536100001Medicare NSC