# CHESAPEAKE HOSPITAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bon Secours Lively Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043700347
- **Authorized official:** KIMBERLY M RALSTON (DIRECTOR REIMBURSEMENT)
- **Authorized official phone:** (419) 996-5119

## Contact information

- **Practice address:** 36 LIVELY OAKS RD, LIVELY, VA 22507
- **Practice address phone:** (804) 462-5155
- **Practice address fax:** (804) 462-5922
- **Mailing address:** 8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
- **Mailing address phone:** (804) 627-5573
- **Mailing address fax:** (866) 449-0896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2018
- **Last updated:** 11/20/2020