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Organization
MARY IMMACULATE NURSING CENTER LLC
Active
Organization
MARY IMMACULATE NURSING CENTER LLC
Active
Other names
Saint Francis Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY RALSTON (SYSTEM DIRECTOR)
(419) 996-5119
Entity
Organization
Contact information
Practice address
4 RIDGEWOOD PKWY, NEWPORT NEWS, VA 23602-4415
(757) 886-6500
(757) 886-6539
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5573
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2695
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004952049
—
VA
01
—
227691
ANTHEM PROVIDER NUMBER
VA
05
—
4952049
—
VA
Enumeration date
05/31/2006
Last updated
10/22/2020
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