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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