Healthcare Provider Details

I. General information

NPI: 1225537657
Provider Name (Legal Business Name): RIVERDALE HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 RIVERDALE DR
CHARLOTTESVILLE VA
22902-4939
US

IV. Provider business mailing address

PO BOX 249
WARSAW VA
22572-0249
US

V. Phone/Fax

Practice location:
  • Phone: 434-293-9845
  • Fax: 434-293-2677
Mailing address:
  • Phone: 804-333-1590
  • Fax: 804-333-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALF361
License Number StateVA

VIII. Authorized Official

Name: THERESA W PACKETT
Title or Position: CORPORATE SPECIALIST
Credential:
Phone: 804-333-1590